Provider Demographics
NPI:1023229358
Name:LAWRENCE, JAGGER BROCK (DC)
Entity type:Individual
Prefix:
First Name:JAGGER
Middle Name:BROCK
Last Name:LAWRENCE
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 1:4940 DEL SOL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2705
Mailing Address - Country:US
Mailing Address - Phone:719-264-9923
Mailing Address - Fax:
Practice Address - Street 1:3261 W CAREFREE CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3004
Practice Address - Country:US
Practice Address - Phone:719-596-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor