Provider Demographics
NPI:1114114253
Name:ROBERSON, LAWRENCE DALLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DALLIN
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:DALLIN
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:19 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1307
Mailing Address - Country:US
Mailing Address - Phone:435-462-4800
Mailing Address - Fax:435-462-4800
Practice Address - Street 1:19 N STATE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1307
Practice Address - Country:US
Practice Address - Phone:435-462-4800
Practice Address - Fax:435-462-4800
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6817296-1202111N00000X
IDCHIA-1236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor