Provider Demographics
NPI:1083665848
Name:LAWRENCE, GREGORY RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RYAN
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 1:6231 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4003
Mailing Address - Country:US
Mailing Address - Phone:812-479-8350
Mailing Address - Fax:812-479-8360
Practice Address - Street 1:6231 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4003
Practice Address - Country:US
Practice Address - Phone:812-479-8350
Practice Address - Fax:812-479-8360
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001987A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200333820AMedicaid
IN198130AMedicare PIN
INU93487Medicare UPIN