Provider Demographics
NPI:1760678999
Name:COTTLE, LAWRENCE D (D C)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:COTTLE
Suffix:
Gender:M
Credentials:D C
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:D
Other - Last Name:COTTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:D C
Mailing Address - Street 1:5086 MATILDA ST
Mailing Address - Street 2:APT. 116
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4271
Mailing Address - Country:US
Mailing Address - Phone:214-987-3326
Mailing Address - Fax:
Practice Address - Street 1:5086 MATILDA ST
Practice Address - Street 2:APT. 116
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4271
Practice Address - Country:US
Practice Address - Phone:214-987-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7833111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition