Provider Demographics
NPI: | 1023164035 |
---|---|
Name: | DR. PATRICIA L. LAWLER D.C. CHARTERED |
Entity type: | Organization |
Organization Name: | DR. PATRICIA L. LAWLER D.C. CHARTERED |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PATRICIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAWLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC, CCN, DACBN |
Authorized Official - Phone: | 651-645-6951 |
Mailing Address - Street 1: | 2324 UNIVERSITY AVE W |
Mailing Address - Street 2: | SUITE NO. 102 |
Mailing Address - City: | SAINT PAUL |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55114-1843 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-645-6951 |
Mailing Address - Fax: | 651-645-6961 |
Practice Address - Street 1: | 2324 UNIVERSITY AVE W |
Practice Address - Street 2: | SUITE NO. 102 |
Practice Address - City: | SAINT PAUL |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55114-1843 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-645-6951 |
Practice Address - Fax: | 651-645-6961 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-25 |
Last Update Date: | 2008-06-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 0014514865 | 111N00000X, 111NI0900X, 111NN0400X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X, 171100000X, 111NN1001X |
132700000X, 133N00000X, 133NN1002X, 175F00000X, 175L00000X, 171M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111NN1001X | Chiropractic Providers | Chiropractor | Nutrition | Group - Multi-Specialty |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 111NI0900X | Chiropractic Providers | Chiropractor | Internist | Group - Multi-Specialty |
No | 111NN0400X | Chiropractic Providers | Chiropractor | Neurology | Group - Multi-Specialty |
No | 111NR0400X | Chiropractic Providers | Chiropractor | Rehabilitation | Group - Multi-Specialty |
No | 111NS0005X | Chiropractic Providers | Chiropractor | Sports Physician | Group - Multi-Specialty |
No | 111NX0100X | Chiropractic Providers | Chiropractor | Occupational Health | Group - Multi-Specialty |
No | 111NX0800X | Chiropractic Providers | Chiropractor | Orthopedic | Group - Multi-Specialty |
No | 132700000X | Dietary & Nutritional Service Providers | Dietary Manager | Group - Multi-Specialty | |
No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | Group - Multi-Specialty |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
No | 175F00000X | Other Service Providers | Naturopath | Group - Multi-Specialty | |
No | 175L00000X | Other Service Providers | Homeopath | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | T39982 | Medicare UPIN | |
MN | 350611018 | Medicare ID - Type Unspecified | MEDICARE - LEGACY NO. |