Provider Demographics
NPI:1801053889
Name:LIRA, LAUREN (DC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:LIRA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 2:1B
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
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY602AMedicare PIN