Provider Demographics
NPI:1487673539
Name:LAWTON, PETER M (DC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:M
Last Name:LAWTON
Suffix:
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 1:109 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003792-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA546427Medicare ID - Type Unspecified
PAT06406Medicare UPIN