Provider Demographics
NPI:1669496238
Name:LAWLOR, JOSHUA (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LAWLOR
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 1:616 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-9694
Mailing Address - Country:US
Mailing Address - Phone:563-285-8230
Mailing Address - Fax:563-285-5122
Practice Address - Street 1:616 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-9694
Practice Address - Country:US
Practice Address - Phone:563-285-8230
Practice Address - Fax:563-285-5122
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00317060OtherRAILROAD MEDICARE
IA0487975Medicaid
IA06368OtherBLUE CROSS BLUE SHIELD
IA06369OtherBLUE CROSS BLUE SHIELD
IA1487975Medicaid
IA0487975Medicaid
IA06369OtherBLUE CROSS BLUE SHIELD
IAI16777Medicare PIN