Provider Demographics
NPI:1881159150
Name:BOURGEIOS, LAWRENCE PAUL III (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PAUL
Last Name:BOURGEIOS
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 2ND ST APT 10
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2137
Mailing Address - Country:US
Mailing Address - Phone:228-216-8333
Mailing Address - Fax:228-863-5616
Practice Address - Street 1:9344 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4268
Practice Address - Country:US
Practice Address - Phone:228-865-9898
Practice Address - Fax:228-863-5616
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor