Provider Demographics
NPI:1063753432
Name:PANZARELLA, LAUREN J (DC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:PANZARELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:JUSTINE PANZARELLA
Other - Last Name:PREIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:96 LAKESHORE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3858
Mailing Address - Country:US
Mailing Address - Phone:912-510-9355
Mailing Address - Fax:912-439-3135
Practice Address - Street 1:96 LAKESHORE DR STE B
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3858
Practice Address - Country:US
Practice Address - Phone:912-510-9355
Practice Address - Fax:912-439-3135
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10846111N00000X
GACHIRO10385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor