Provider Demographics
NPI:1225119233
Name:DIETER, LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:DIETER
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:PO BOX 15858
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-5858
Mailing Address - Country:US
Mailing Address - Phone:805-544-0237
Mailing Address - Fax:
Practice Address - Street 1:1171 TORO ST
Practice Address - Street 2:C
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3308
Practice Address - Country:US
Practice Address - Phone:805-544-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20076111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor