Provider Demographics
NPI:1699831974
Name:CALDERON, LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:CALDERON
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 1:3333 SOQUEL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2054
Mailing Address - Country:US
Mailing Address - Phone:831-465-9344
Mailing Address - Fax:831-465-9340
Practice Address - Street 1:3333 SOQUEL DR
Practice Address - Street 2:SUITE C
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2054
Practice Address - Country:US
Practice Address - Phone:831-465-9344
Practice Address - Fax:831-465-9340
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor