Provider Demographics
NPI:1871866517
Name:LAWRENCE R FREE DC PA
Entity Type:Organization
Organization Name:LAWRENCE R FREE DC PA
Other - Org Name:TYRONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LENHOLT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:727-345-7427
Mailing Address - Street 1:500 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7125
Mailing Address - Country:US
Mailing Address - Phone:727-345-7427
Mailing Address - Fax:727-347-1172
Practice Address - Street 1:500 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7125
Practice Address - Country:US
Practice Address - Phone:727-345-7427
Practice Address - Fax:727-347-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381486600Medicaid
FL381486600Medicaid