Provider Demographics
NPI:1366464406
Name:LAWTON CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LAWTON CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-934-3911
Mailing Address - Street 1:109 GATEWAY AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8471
Mailing Address - Country:US
Mailing Address - Phone:724-934-3911
Mailing Address - Fax:724-934-2860
Practice Address - Street 1:109 GATEWAY AVE
Practice Address - Street 2:STE 101
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8471
Practice Address - Country:US
Practice Address - Phone:724-934-3911
Practice Address - Fax:724-934-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003792-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA546427Medicare ID - Type Unspecified
PAT06406Medicare UPIN