Provider Demographics
NPI:1043306962
Name:ANDERSON, LAWRENCE EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:ANDERSON
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 1:206 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-1347
Mailing Address - Country:US
Mailing Address - Phone:205-647-0044
Mailing Address - Fax:205-647-0044
Practice Address - Street 1:206 MAIN ST N
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-1347
Practice Address - Country:US
Practice Address - Phone:205-647-0044
Practice Address - Fax:205-647-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000070443Medicare ID - Type Unspecified
ALT68317Medicare UPIN