Provider Demographics
NPI:1164680963
Name:LAWSON, JARED JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:JACK
Last Name:LAWSON
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 1:11 OAK ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5159
Mailing Address - Country:US
Mailing Address - Phone:207-622-3330
Mailing Address - Fax:207-622-3335
Practice Address - Street 1:11 OAK ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5159
Practice Address - Country:US
Practice Address - Phone:207-622-3330
Practice Address - Fax:207-622-3335
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor