Provider Demographics
NPI:1336156173
Name:KORMAN, LAURA R (DC, PA)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:R
Last Name:KORMAN
Suffix:
Gender:F
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16954 TOLEDO BLADE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-1674
Mailing Address - Country:US
Mailing Address - Phone:941-629-6700
Mailing Address - Fax:941-629-6805
Practice Address - Street 1:16954 TOLEDO BLADE BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-1674
Practice Address - Country:US
Practice Address - Phone:941-629-6700
Practice Address - Fax:941-629-6805
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005942111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22466OtherBLUE CROSS/BLUE SHIELD
FL380931500Medicaid
FLU21678Medicare UPIN
FLBJ341AMedicare PIN
FL380931500Medicaid