Provider Demographics
NPI:1518355916
Name:JURENKO, ELIZABETH L
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:JURENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:LANDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:844 N STONE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3208
Mailing Address - Country:US
Mailing Address - Phone:386-734-2592
Mailing Address - Fax:386-734-1773
Practice Address - Street 1:844 N STONE ST
Practice Address - Street 2:STE 202
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3208
Practice Address - Country:US
Practice Address - Phone:386-734-2592
Practice Address - Fax:386-734-1773
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11386111N00000X
FLAL32032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer