Provider Demographics
NPI:1023104759
Name:BREWERTON, LAWRENCE OWEN (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:OWEN
Last Name:BREWERTON
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 1:131 N COMMON RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1054
Mailing Address - Country:US
Mailing Address - Phone:978-874-9914
Mailing Address - Fax:
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3785
Practice Address - Country:US
Practice Address - Phone:978-534-6246
Practice Address - Fax:978-534-6268
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA64675OtherUNITED HEALTH CARE
MAY35933OtherBLUE CROSS/BLUE SHIELD
MA0781813OtherAETNA
MA8107760OtherCIGNA
MA35252OtherHARVARD PILGRIM
MA722255OtherTUFTS HEALTH PLANS
MA35252OtherHARVARD PILGRIM
MA8107760OtherCIGNA