Provider Demographics
NPI:1881619179
Name:LORD, KAREN (DC)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:LORD
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 1:483 E C 48
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-8331
Mailing Address - Country:US
Mailing Address - Phone:352-793-3322
Mailing Address - Fax:352-569-5820
Practice Address - Street 1:1122 W C 48
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-8970
Practice Address - Country:US
Practice Address - Phone:352-793-3322
Practice Address - Fax:352-569-5820
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH005256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050231601Medicaid
FL70873OtherBLUE CROSS/BLUE SHIELD
FL050231601Medicaid
FL70873OtherBLUE CROSS/BLUE SHIELD