Healthcare Provider Details

I. General information

NPI: 1689708943
Provider Name (Legal Business Name): ROBERT LEE LAWRENCE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 N. MILITARY TRAIL #208
PALM BEACH GARDENS FL
33410
US

IV. Provider business mailing address

1907 SW 22 WAY
BOYNTON BEACH FL
33416
US

V. Phone/Fax

Practice location:
  • Phone: 561-722-9637
  • Fax:
Mailing address:
  • Phone: 561-738-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH4328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: