Provider Demographics
NPI:1811068125
Name:LAWRENCE, VIRGINIA SHANNON (DC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SHANNON
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:LAWRENCE
Other - Last Name:SHRIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:827 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4836
Mailing Address - Country:US
Mailing Address - Phone:303-485-8586
Mailing Address - Fax:
Practice Address - Street 1:724 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5006
Practice Address - Country:US
Practice Address - Phone:303-449-3103
Practice Address - Fax:303-402-1095
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801294Medicare ID - Type Unspecified