Provider Demographics
NPI:1780958546
Name:LAWRIE, ELAINE JACKLYN (DC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:JACKLYN
Last Name:LAWRIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 PURDUE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5314
Mailing Address - Country:US
Mailing Address - Phone:919-326-1902
Mailing Address - Fax:
Practice Address - Street 1:708 PURDUE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5314
Practice Address - Country:US
Practice Address - Phone:919-749-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor