Provider Demographics
NPI:1669422564
Name:LAURENCE, CHAD EVAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EVAN
Last Name:LAURENCE
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 1:7503 LANCASTER PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9593
Mailing Address - Country:US
Mailing Address - Phone:302-234-1115
Mailing Address - Fax:302-234-6661
Practice Address - Street 1:7503 A LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9593
Practice Address - Country:US
Practice Address - Phone:302-234-1115
Practice Address - Fax:302-234-6661
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1467402362OtherGROUP NPI NUMBER
DE1669422564OtherNPI TYPE ONE
2257974000OtherIBC
DEG01606Medicare PIN
DE1467402362OtherGROUP NPI NUMBER
DE1669422564OtherNPI TYPE ONE