Provider Demographics
NPI:1326018862
Name:LAWRENCE, EROSA S (DC)
Entity Type:Individual
Prefix:DR
First Name:EROSA
Middle Name:S
Last Name:LAWRENCE
Suffix:
Gender:F
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 1048
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65673-1048
Mailing Address - Country:US
Mailing Address - Phone:417-332-0000
Mailing Address - Fax:
Practice Address - Street 1:213 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2423
Practice Address - Country:US
Practice Address - Phone:417-332-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80038Medicare UPIN