Healthcare Provider Details

I. General information

NPI: 1982720900
Provider Name (Legal Business Name): LAWRENCE DAVID PAULE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9418 W VAN BUREN ST
TOLLESON AZ
85353-2805
US

IV. Provider business mailing address

9418 W VAN BUREN ST
TOLLESON AZ
85353-2805
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-5678
  • Fax: 623-936-9899
Mailing address:
  • Phone: 623-936-5678
  • Fax: 623-936-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number4584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: