Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MA54290 | FL |
NPI | 1295976462 |
---|---|
Provider Name | Mr. Larance Ford II |
First Address | Ft Lauderdale, FL 33311-4757 |
Second Address | Ft Lauderdale, FL 33311-4757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 17/03/2009 |