NPIMap

Organization Active NPI

Port Charlotte Chiropractic LLC

  • Chiropractor
  • Port Charlotte, FL
National Provider Identifier
1356090245
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PORT CHARLOTTE CHIROPRACTIC LLC
Practice address
795 Crestview Cir NW
Port Charlotte, FL 33948-2126
Phone
(941) 629-8444
NPI assigned
Mar 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lawrence C Wallen III, DC
Title
Chiropractor
Phone
(815) 252-9783

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

795 Crestview Cir NW
Port Charlotte, FL 33948-2126

Mailing address

795 Crestview Cir NW
Port Charlotte, FL 33948-2126

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL portcharlottechiropractic@gmail.com Direct

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1356090245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 CRESTVIEW CIR NW",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339482126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 CRESTVIEW CIR NW",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339482126",
            "telephone_number": "941-629-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CHARLOTTE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-20",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "WALLEN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "815-252-9783",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "portcharlottechiropractic@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "795 Crestview Cir NW",
            "city": "Port Charlotte",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339482126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.