Provider Demographics
NPI:1760458038
Name:LAWLESS, STEVEN R (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:LAWLESS
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 1:16921B MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1209
Mailing Address - Country:US
Mailing Address - Phone:636-405-2777
Mailing Address - Fax:636-273-6835
Practice Address - Street 1:16921B MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1209
Practice Address - Country:US
Practice Address - Phone:636-405-2777
Practice Address - Fax:636-273-6835
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31865Medicare ID - Type Unspecified
MOU82964Medicare UPIN