Provider Demographics
NPI:1912955170
Name:LAWYER CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:LAWYER CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOLERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-353-2211
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-0279
Mailing Address - Country:US
Mailing Address - Phone:740-353-2211
Mailing Address - Fax:740-353-4373
Practice Address - Street 1:1616 GRANT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3663
Practice Address - Country:US
Practice Address - Phone:740-353-2211
Practice Address - Fax:740-353-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5930627OtherAETNA
OH0901242Medicaid
OH000000228032OtherANTHEM
OHCE0510OtherRAIL ROAD MEDICARE
OH5930627OtherAETNA
OH5930627OtherAETNA