Provider Demographics
NPI:1396719522
Name:LAWLOR, JASON CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
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 1:16801 NEWBURGH RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1606
Mailing Address - Country:US
Mailing Address - Phone:734-432-7071
Mailing Address - Fax:734-432-7940
Practice Address - Street 1:16801 NEWBURGH RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1606
Practice Address - Country:US
Practice Address - Phone:734-432-7071
Practice Address - Fax:734-432-7940
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU87869Medicare UPIN
MI0P29930Medicare PIN