Provider Demographics
NPI:1811224231
Name:LAUREN E LIRA D.C., INC
Entity Type:Organization
Organization Name:LAUREN E LIRA D.C., INC
Other - Org Name:FUSION HEALTH WELLNESS AND RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-401-4521
Mailing Address - Street 1:2750 NE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1732
Mailing Address - Country:US
Mailing Address - Phone:904-401-4521
Mailing Address - Fax:954-990-7292
Practice Address - Street 1:1164 E OAKLAND PARK BLVD
Practice Address - Street 2:102
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2707
Practice Address - Country:US
Practice Address - Phone:954-900-5635
Practice Address - Fax:954-990-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5789101YA0400X
FLCH9406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY602AMedicare PIN
FLCY602AMedicare PIN