Provider Demographics
NPI:1972218642
Name:LAVENDER, VICTORIA FAITH (DC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:FAITH
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6258 BLAKEFORD DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5604
Mailing Address - Country:US
Mailing Address - Phone:407-713-1172
Mailing Address - Fax:
Practice Address - Street 1:427 S PARSONS AVE STE 118
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5252
Practice Address - Country:US
Practice Address - Phone:813-278-5040
Practice Address - Fax:813-856-5390
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor