Provider Demographics
NPI:1871059519
Name:KREULEN, LORI SUZANNE (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:SUZANNE
Last Name:KREULEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DIVINE LIFE
Other - Middle Name:HEALTH
Other - Last Name:SERVICES, PA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LEGAL BUSINESS NAME
Mailing Address - Street 1:6040 BAY LN
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33876-6401
Mailing Address - Country:US
Mailing Address - Phone:863-446-2347
Mailing Address - Fax:
Practice Address - Street 1:249 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2132
Practice Address - Country:US
Practice Address - Phone:863-446-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor