Healthcare Provider Details

I. General information

NPI: 1235218108
Provider Name (Legal Business Name): LAWRENCE JOHN CIPOLONE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 HANOVER AVE
ALLENTOWN PA
18109-8140
US

IV. Provider business mailing address

1916 HANOVER AVE
ALLENTOWN PA
18109-8140
US

V. Phone/Fax

Practice location:
  • Phone: 610-776-2772
  • Fax:
Mailing address:
  • Phone: 610-776-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-005519-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: