Provider Demographics
NPI:1982677886
Name:LOW, LAWRENCE (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LOW
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 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3001
Mailing Address - Country:US
Mailing Address - Phone:719-846-4990
Mailing Address - Fax:
Practice Address - Street 1:165 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3001
Practice Address - Country:US
Practice Address - Phone:719-846-4990
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1789-3Medicare UPIN