Provider Demographics
NPI:1679630354
Name:NUZUM, LORRA (DC)
Entity type:Individual
Prefix:DR
First Name:LORRA
Middle Name:
Last Name:NUZUM
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 1:1400 HAND AVE
Mailing Address - Street 2:SUITE S
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8194
Mailing Address - Country:US
Mailing Address - Phone:386-673-0400
Mailing Address - Fax:386-673-1825
Practice Address - Street 1:1400 HAND AVE
Practice Address - Street 2:SUITE S
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8194
Practice Address - Country:US
Practice Address - Phone:386-673-0400
Practice Address - Fax:386-673-1825
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2214Medicare PIN