Provider Demographics
NPI:1902012115
Name:BELLOWS, LAWRENCE T (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:T
Last Name:BELLOWS
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 1:107 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1305
Mailing Address - Country:US
Mailing Address - Phone:570-662-0927
Mailing Address - Fax:570-662-2406
Practice Address - Street 1:107 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1305
Practice Address - Country:US
Practice Address - Phone:570-662-0927
Practice Address - Fax:570-662-2406
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007162L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor