Provider Demographics
NPI:1518628452
Name:LAVENDER FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LAVENDER FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-219-8033
Mailing Address - Street 1:6091 MEDICI CT APT 310
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5637
Mailing Address - Country:US
Mailing Address - Phone:815-219-8033
Mailing Address - Fax:
Practice Address - Street 1:6091 MEDICI CT APT 310
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5637
Practice Address - Country:US
Practice Address - Phone:815-219-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty