Provider Demographics
NPI:1275098600
Name:LAWANSON, CAL
Entity Type:Individual
Prefix:
First Name:CAL
Middle Name:
Last Name:LAWANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 NE CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2091
Mailing Address - Country:US
Mailing Address - Phone:816-332-5823
Mailing Address - Fax:
Practice Address - Street 1:9625 NE CHERRY CT
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2091
Practice Address - Country:US
Practice Address - Phone:816-332-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175L00000XOther Service ProvidersHomeopath