Provider Demographics
NPI:1659399715
Name:ALSTON, LORENZO ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:ALLEN
Last Name:ALSTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6148
Mailing Address - Country:US
Mailing Address - Phone:215-732-7873
Mailing Address - Fax:215-520-5150
Practice Address - Street 1:2300 WALNUT ST
Practice Address - Street 2:SUITE 218
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5552
Practice Address - Country:US
Practice Address - Phone:215-520-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006361L111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC006361LOtherSTATE LICENSE NUMBER