Provider Demographics
NPI:1902999063
Name:WOLOSHEN, LAURIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANN
Last Name:WOLOSHEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N HOWARD AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1244
Mailing Address - Country:US
Mailing Address - Phone:813-254-3900
Mailing Address - Fax:813-254-3994
Practice Address - Street 1:501 N HOWARD AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1244
Practice Address - Country:US
Practice Address - Phone:813-254-3900
Practice Address - Fax:813-254-3994
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U31822Medicare UPIN
22754Medicare ID - Type Unspecified