Provider Demographics
NPI:1689085052
Name:LAWRENCE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:LAWRENCE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIP OM
Authorized Official - Phone:785-371-1141
Mailing Address - Street 1:843 NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2739
Mailing Address - Country:US
Mailing Address - Phone:785-371-1141
Mailing Address - Fax:785-246-5809
Practice Address - Street 1:843 NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2739
Practice Address - Country:US
Practice Address - Phone:785-371-1141
Practice Address - Fax:785-371-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16070171100000X
KS2300013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty