Provider Demographics
NPI:1881691913
Name:BRIDGES, LAWRENCE E (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:BRIDGES
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 1:2 EMERALD TER
Mailing Address - Street 2:STE B
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2317
Mailing Address - Country:US
Mailing Address - Phone:618-234-8000
Mailing Address - Fax:618-234-8092
Practice Address - Street 1:2 EMERALD TER
Practice Address - Street 2:STE B
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2317
Practice Address - Country:US
Practice Address - Phone:618-234-8000
Practice Address - Fax:618-234-8092
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor