Basic Information
| Provider Information | |||||||||
| NPI: | 1356590236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWSON CHIROPRACTIC CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 657 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433010657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837947 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433024450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403871509 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7403837922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC.469 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 000000116873 | 01 | OH | ANTHEM | OTHER |