Provider Demographics
NPI:1033127220
Name:LAWLESS, BRIAN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:LAWLESS
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 1:654 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3244
Mailing Address - Country:US
Mailing Address - Phone:732-842-7910
Mailing Address - Fax:732-842-7810
Practice Address - Street 1:654 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3244
Practice Address - Country:US
Practice Address - Phone:732-842-7910
Practice Address - Fax:732-842-7810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00515900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38320Medicare ID - Type Unspecified