MEDICARE: DR. LARS LANDERS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	CH 12173	FL

General Provider Information

NPI Number	:	1275818874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARS LANDERS D.C.

Provider Business Mailing Address
First Line	:	5111 S RIDGEWOOD AVE
Second Line	:	SUITE 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5111 S RIDGEWOOD AVE
Second Line	:	SUITE 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5169
Country	:	US
Telephone Number	:	386-366-8198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	05/06/2017

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