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NPI Code Detail

MEDICARE: MR. LAWRENCE REGINALD PERDUE DC

MEDICARE: MR. LAWRENCE REGINALD PERDUE DC
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
1111N00000XChiropractorCH006225FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1310495600OTHERFLWORKERS COMP
222704OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1427144930
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LAWRENCE REGINALD PERDUE DC
Provider Business Mailing Address
First Line : 1051 PORT MALABAR BLVD NE
Second Line : SUITE 2
City : PALM BAY
State : FL
Zip : 32905-5153
Country : US
Telephone Number : 321-984-5355
Fax Number : 321-984-7206
Provider Business Practice Location Address
First Line : 1051 PORT MALABAR BLVD NE
Second Line : SUITE 2
City : PALM BAY
State : FL
Zip : 32905-5153
Country : US
Telephone Number : 321-984-5355
Fax Number : 321-984-7206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 06/01/2012

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Directions to “ MR. LAWRENCE REGINALD PERDUE DC” Practice Location

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