Provider Demographics
NPI:1629024716
Name:LAURANCE, ANNA L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:L
Last Name:LAURANCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4527
Mailing Address - Country:US
Mailing Address - Phone:727-547-8615
Mailing Address - Fax:727-547-0918
Practice Address - Street 1:8695 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4527
Practice Address - Country:US
Practice Address - Phone:727-547-8615
Practice Address - Fax:727-547-0918
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO7061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381162000Medicaid
FL21267Medicare ID - Type Unspecified
FL381162000Medicaid