Healthcare Provider Details

I. General information

NPI: 1629024716
Provider Name (Legal Business Name): ANNA L LAURANCE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 66TH ST
PINELLAS PARK FL
33782-4527
US

IV. Provider business mailing address

8695 66TH ST
PINELLAS PARK FL
33782-4527
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-8615
  • Fax: 727-547-0918
Mailing address:
  • Phone: 727-547-8615
  • Fax: 727-547-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHOOO7061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: