Provider Demographics
NPI:1023172749
Name:LAWRENCE, DANA JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:JEFFREY
Last Name:LAWRENCE
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 1:741 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5209
Mailing Address - Country:US
Mailing Address - Phone:563-884-5302
Mailing Address - Fax:563-884-5227
Practice Address - Street 1:741 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5209
Practice Address - Country:US
Practice Address - Phone:563-884-5302
Practice Address - Fax:563-884-5227
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor