Provider Demographics
NPI:1548337504
Name:SHELL, LAWRENCE J (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:SHELL
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:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-1272
Mailing Address - Country:US
Mailing Address - Phone:508-833-0433
Mailing Address - Fax:508-833-0822
Practice Address - Street 1:68 TUPPER RD
Practice Address - Street 2:UNIT 11
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-1872
Practice Address - Country:US
Practice Address - Phone:508-833-0433
Practice Address - Fax:508-833-0822
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1611275Medicaid
MAY36389OtherBLUE CROSS BLUE SHIELD
MA35804OtherHARVARD PILGRIM
561338OtherAETNA
MAY45030Medicare ID - Type Unspecified