Healthcare Provider Details

I. General information

NPI: 1972543528
Provider Name (Legal Business Name): ROBERT CORY LAWRENCE LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W NC HIGHWAY 54 STE 300-126
DURHAM NC
27707-5577
US

IV. Provider business mailing address

1415 W NC HIGHWAY 54 STE 300-126
DURHAM NC
27707-5577
US

V. Phone/Fax

Practice location:
  • Phone: 919-750-0027
  • Fax: 910-621-0003
Mailing address:
  • Phone: 919-750-0027
  • Fax: 910-621-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: