Provider Demographics
NPI:1679574677
Name:LIEURANCE, JOHN A (DC, NMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:LIEURANCE
Suffix:
Gender:M
Credentials:DC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S TAMIAMI TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3805
Mailing Address - Country:US
Mailing Address - Phone:941-330-8553
Mailing Address - Fax:941-330-9853
Practice Address - Street 1:2222 S TAMIAMI TRL
Practice Address - Street 2:SUITE C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3805
Practice Address - Country:US
Practice Address - Phone:941-330-8553
Practice Address - Fax:941-330-9853
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-03-14
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLCH0007524111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU62386Medicare UPIN
FL55707Medicare ID - Type Unspecified