Provider Demographics
NPI:1699846543
Name:MORITKO, LAWRENCE (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:MORITKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 101ST LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-7602
Mailing Address - Country:US
Mailing Address - Phone:763-568-4109
Mailing Address - Fax:763-780-3789
Practice Address - Street 1:1124 101ST LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-7602
Practice Address - Country:US
Practice Address - Phone:763-568-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3064111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor