Healthcare Provider Details

I. General information

NPI: 1356167993
Provider Name (Legal Business Name): KENG JUSTIN LOR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 GEER RD STE B
TURLOCK CA
95382-1111
US

IV. Provider business mailing address

2881 GEER RD STE B
TURLOCK CA
95382-1111
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-8592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: