Provider Demographics
NPI:1083752406
Name:LAWHEADHOFFMAN, LAURAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURAN
Middle Name:
Last Name:LAWHEADHOFFMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1647
Mailing Address - Country:US
Mailing Address - Phone:712-642-5023
Mailing Address - Fax:712-642-4605
Practice Address - Street 1:504 E ERIE ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1647
Practice Address - Country:US
Practice Address - Phone:712-642-5023
Practice Address - Fax:712-642-4605
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO6168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48209Medicare ID - Type Unspecified