Provider Demographics
NPI:1760599914
Name:SVENDSEN, LAWRENCE ALFRED (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALFRED
Last Name:SVENDSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:A
Other - Last Name:SVENDSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC PC
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-1268
Mailing Address - Country:US
Mailing Address - Phone:970-565-7315
Mailing Address - Fax:970-565-7315
Practice Address - Street 1:501 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321
Practice Address - Country:US
Practice Address - Phone:970-565-7315
Practice Address - Fax:970-565-7315
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08113607Medicaid
12643Medicare ID - Type Unspecified
CO08113607Medicaid