Provider Demographics
NPI:1427269273
Name:LAWICKI, LAWRENCE PATRICK (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:PATRICK
Last Name:LAWICKI
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 1:201 CONCOURSE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5640
Mailing Address - Country:US
Mailing Address - Phone:804-527-0092
Mailing Address - Fax:804-527-0211
Practice Address - Street 1:201 CONCOURSE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5640
Practice Address - Country:US
Practice Address - Phone:804-527-0092
Practice Address - Fax:804-527-0211
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556535OtherVA STATE MEDICAL LICENSE
VA00X805R01Medicare PIN