Provider Demographics
NPI:1679536056
Name:BAGNELL, LAWRENCE C
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:BAGNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CORPORATE DR E
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8009
Mailing Address - Country:US
Mailing Address - Phone:215-504-2711
Mailing Address - Fax:
Practice Address - Street 1:301 CORPORATE DR E
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8009
Practice Address - Country:US
Practice Address - Phone:215-504-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004829L111N00000X
FLCH6467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000187130901OtherUNITED HEALTHCARE
PA892912OtherHIGHMARK BLUE SHIELD
PA0141730000OtherINDEPENDENCE BLUE CROSS
PAU49782Medicare UPIN
PA892912Medicare ID - Type Unspecified