Provider Demographics
NPI:1447451000
Name:LAWRENCE CHIROPRACTIC AND REHABILITATION INC
Entity type:Organization
Organization Name:LAWRENCE CHIROPRACTIC AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-479-8350
Mailing Address - Street 1:6231 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4003
Mailing Address - Country:US
Mailing Address - Phone:812-479-8350
Mailing Address - Fax:812-479-8360
Practice Address - Street 1:6231 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4003
Practice Address - Country:US
Practice Address - Phone:812-479-8350
Practice Address - Fax:812-479-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001987A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200333820AMedicaid
INU93487Medicare UPIN
IN200333820AMedicaid