Provider Demographics
NPI:1679667505
Name:LAWSON, ROGER LLOYD (DC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LLOYD
Last Name:LAWSON
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 1:165 SOUTH OAK
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114
Mailing Address - Country:US
Mailing Address - Phone:509-684-4456
Mailing Address - Fax:509-684-4456
Practice Address - Street 1:165 SOUTH OAK
Practice Address - Street 2:SUITE A
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114
Practice Address - Country:US
Practice Address - Phone:509-684-4456
Practice Address - Fax:509-684-4456
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001798111N00000X
OR281878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2004976Medicaid
WA2004976Medicaid
WA000300863Medicare ID - Type Unspecified