Provider Demographics
NPI:1295000933
Name:BRIAN E. LAWLESS D.C.,P.C.
Entity Type:Organization
Organization Name:BRIAN E. LAWLESS D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-842-7910
Mailing Address - Street 1:654 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3244
Mailing Address - Country:US
Mailing Address - Phone:732-842-7910
Mailing Address - Fax:732-842-7810
Practice Address - Street 1:654 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3244
Practice Address - Country:US
Practice Address - Phone:732-842-7910
Practice Address - Fax:732-842-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00515900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038320Medicare UPIN