Provider Demographics
NPI:1629020797
Name:BAVARO LAWLOR, KAREN (DC DACAN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BAVARO LAWLOR
Suffix:
Gender:F
Credentials:DC DACAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITE OAK ROAD
Mailing Address - Street 2:BAVARO CHIROPRACTIC CENTER LLC
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798
Mailing Address - Country:US
Mailing Address - Phone:203-263-2720
Mailing Address - Fax:203-266-9058
Practice Address - Street 1:2 WHITE OAK ROAD
Practice Address - Street 2:BAVARO CHIROPRACTIC CENTER LLC
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798
Practice Address - Country:US
Practice Address - Phone:203-263-2720
Practice Address - Fax:203-266-9058
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT00832OtherLANDMARK HEALTHCARE PHS
CTH0566068OtherAETNA HMO
CT050000832CT03OtherBLUE CROSS BLUE SHIELD
CT00412299100OtherBLUE CARE FAMILY PLAN
CT0985089OtherAETNA
CTCT00832OtherLANDMARK HEALTHCARE PHS