Provider Demographics
NPI:1295976462
Name:FORD, LARANCE II (LMT)
Entity type:Individual
Prefix:MR
First Name:LARANCE
Middle Name:
Last Name:FORD
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4757
Mailing Address - Country:US
Mailing Address - Phone:786-343-9911
Mailing Address - Fax:
Practice Address - Street 1:1141 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-4757
Practice Address - Country:US
Practice Address - Phone:786-343-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54290111NR0400X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No173C00000XOther Service ProvidersReflexologist