Provider Demographics
NPI:1730104316
Name:DORAN, LAWRENCE PAUL (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:PAUL
Last Name:DORAN
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 1:6534 LAKE MICHIGAN DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9228
Mailing Address - Country:US
Mailing Address - Phone:616-895-5499
Mailing Address - Fax:616-895-5206
Practice Address - Street 1:6534 LAKE MICHIGAN DRIVE
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9228
Practice Address - Country:US
Practice Address - Phone:616-895-5499
Practice Address - Fax:616-895-5206
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILD005248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI141735626Medicaid
MI950G010890OtherBLUE CROSS BLUE SHIELD
MIP31651FOtherBLUE CARE NETWORK
MI141735626Medicaid
T33501Medicare UPIN