Provider Demographics
NPI:1629152095
Name:REUTER, LAWRENCE J (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:REUTER
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 1:4675 N SHALLOWFORD RD
Mailing Address - Street 2:#100
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-455-4547
Mailing Address - Fax:770-451-8604
Practice Address - Street 1:4675 N SHALLOWFORD RD
Practice Address - Street 2:#100
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-455-4547
Practice Address - Fax:770-451-8604
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO01220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor