Provider Demographics
NPI:1730341538
Name:LAURA R. KORMAN DC PA
Entity type:Organization
Organization Name:LAURA R. KORMAN DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-629-6700
Mailing Address - Street 1:20101 PEACHLAND BLVD
Mailing Address - Street 2:UNIT 209
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2180
Mailing Address - Country:US
Mailing Address - Phone:941-629-6700
Mailing Address - Fax:941-629-6805
Practice Address - Street 1:20101 PEACHLAND BLVD
Practice Address - Street 2:UNIT 209
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2180
Practice Address - Country:US
Practice Address - Phone:941-629-6700
Practice Address - Fax:941-629-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380931500Medicaid
FL22466OtherBC/BS
FL380931500Medicaid
FL22466Medicare PIN