Provider Demographics
NPI:1871992859
Name:CHURCHILL, LAURENCE HAROLD (DC)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:HAROLD
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 SW 34TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7502
Mailing Address - Country:US
Mailing Address - Phone:352-622-4555
Mailing Address - Fax:352-861-4577
Practice Address - Street 1:3235 SW 34TH ST STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7502
Practice Address - Country:US
Practice Address - Phone:352-622-4555
Practice Address - Fax:352-861-4577
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor