Provider Demographics
NPI:1164624755
Name:LAWRENCE, GARY C (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:C
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 1:215 WILLIAM ST N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4723
Mailing Address - Country:US
Mailing Address - Phone:651-439-6285
Mailing Address - Fax:651-439-6290
Practice Address - Street 1:215 WILLIAM ST N
Practice Address - Street 2:SUITE 1
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4723
Practice Address - Country:US
Practice Address - Phone:651-439-6285
Practice Address - Fax:651-439-6290
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor