Provider Demographics
NPI:1548760804
Name:LAWRENCE SPINE & WELLNESS PA
Entity Type:Organization
Organization Name:LAWRENCE SPINE & WELLNESS PA
Other - Org Name:LAWRENCE SPINE & WELLNESS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-709-7625
Mailing Address - Street 1:558 LAWRENCE SQUARE BLVD SOUTH
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-585-6100
Mailing Address - Fax:
Practice Address - Street 1:558 LAWRENCE SQUARE BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-585-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00445200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty