Provider Demographics
NPI:1366757700
Name:URIG, LORA JANE (DC)
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:JANE
Last Name:URIG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LORA
Other - Middle Name:JANE
Other - Last Name:VAQUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4045 BONITA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1334
Mailing Address - Country:US
Mailing Address - Phone:619-575-2588
Mailing Address - Fax:619-764-4076
Practice Address - Street 1:1340 IMPERIAL BEACH BLVD
Practice Address - Street 2:100
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-3046
Practice Address - Country:US
Practice Address - Phone:619-575-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor