Provider Demographics
NPI:1629295514
Name:LEA LAWSON CHIROPRACTIC
Entity Type:Organization
Organization Name:LEA LAWSON CHIROPRACTIC
Other - Org Name:CHARLESTOWN ROAD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-944-4457
Mailing Address - Street 1:4602 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9557
Mailing Address - Country:US
Mailing Address - Phone:812-944-4455
Mailing Address - Fax:812-944-4457
Practice Address - Street 1:4602 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9557
Practice Address - Country:US
Practice Address - Phone:812-944-4455
Practice Address - Fax:812-944-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200468480AMedicaid