Provider Demographics
NPI:1013263391
Name:LAWLOR, JEFFREY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:LAWLOR
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 1:6028 WELDON SPRING PKWY
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-9103
Mailing Address - Country:US
Mailing Address - Phone:636-300-8250
Mailing Address - Fax:
Practice Address - Street 1:6028 WELDON SPRING PKWY
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9103
Practice Address - Country:US
Practice Address - Phone:636-300-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor