Provider Demographics
NPI:1427144930
Name:PERDUE, LAWRENCE REGINALD (DC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:REGINALD
Last Name:PERDUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1051 PORT MALABAR BLVD NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5153
Mailing Address - Country:US
Mailing Address - Phone:321-984-5355
Mailing Address - Fax:321-984-7206
Practice Address - Street 1:1051 PORT MALABAR BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5153
Practice Address - Country:US
Practice Address - Phone:321-984-5355
Practice Address - Fax:321-984-7206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH006225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL310495600OtherWORKERS COMP
FL22704OtherBLUE CROSS BLUE SHIELD
FL22704OtherBLUE CROSS BLUE SHIELD
FLU24560Medicare UPIN