1669496238 NPI number — JOSHUA LAWLOR DC

Table of content: JOSHUA LAWLOR DC (NPI 1669496238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669496238 NPI number — JOSHUA LAWLOR DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWLOR
Provider First Name:
JOSHUA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669496238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 PARKVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELDRIDGE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52748-9694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-285-8230
Provider Business Mailing Address Fax Number:
563-285-5122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 PARKVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDRIDGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52748-9694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-285-8230
Provider Business Practice Location Address Fax Number:
563-285-5122
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  06836 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00317060 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0487975 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06368 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 06369 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1487975 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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