Healthcare Provider Details

I. General information

NPI: 1336107739
Provider Name (Legal Business Name): RYAN M LAWRENCE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 SPANISH FORT BLVD
SPANISH FORT AL
36527-5403
US

IV. Provider business mailing address

8011 SPANISH FORT BLVD
SPANISH FORT AL
36527-5403
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-1999
  • Fax: 251-625-8889
Mailing address:
  • Phone: 251-625-1999
  • Fax: 251-625-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2124
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: