Provider Demographics
NPI:1285649160
Name:BAGWELL, LONNIE ROBERT II (DC)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:ROBERT
Last Name:BAGWELL
Suffix:II
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 1:148 AMBER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6421
Mailing Address - Country:US
Mailing Address - Phone:704-248-8150
Mailing Address - Fax:
Practice Address - Street 1:10310 FELD FARM LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8523
Practice Address - Country:US
Practice Address - Phone:704-759-9020
Practice Address - Fax:704-759-9022
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor