Provider Demographics
NPI:1609984624
Name:LAWLOR, JODY M (DC)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:M
Last Name:LAWLOR
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 1:41278 MARGARITA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5579
Mailing Address - Country:US
Mailing Address - Phone:951-693-0503
Mailing Address - Fax:951-329-3344
Practice Address - Street 1:41278 MARGARITA RD STE 103
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5579
Practice Address - Country:US
Practice Address - Phone:951-693-0503
Practice Address - Fax:951-329-3344
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0191870Medicare ID - Type Unspecified