Provider Demographics
NPI:1578658472
Name:LOVE, LAWSON BLAYNE (DC)
Entity Type:Individual
Prefix:MR
First Name:LAWSON
Middle Name:BLAYNE
Last Name:LOVE
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 1:2800 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4106
Mailing Address - Country:US
Mailing Address - Phone:817-285-8844
Mailing Address - Fax:817-285-8861
Practice Address - Street 1:2800 BROWN TRL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4106
Practice Address - Country:US
Practice Address - Phone:817-285-8844
Practice Address - Fax:817-285-8861
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1324OtherBCBS PROVIDER NUMBER
TX8C7387Medicare ID - Type UnspecifiedMEDICARE