Healthcare Provider Details

I. General information

NPI: 1801894589
Provider Name (Legal Business Name): WILLIAM J LAURETTI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 S FREDERICK AVE SUITE 500
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

16220 S FREDERICK AVE SUITE 500
GAITHERSBURG MD
20877-4039
US

V. Phone/Fax

Practice location:
  • Phone: 301-258-8877
  • Fax: 301-208-1188
Mailing address:
  • Phone: 301-258-8877
  • Fax: 301-208-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1469-PT
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: