MEDICARE: LAWRENCE CHIROPRACTIC CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	383	LA

General Provider Information

NPI Number	:	1215091848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	6224 HEARNE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-4322
Country	:	US
Telephone Number	:	318-525-0525
Fax Number	:	318-525-1272

Provider Business Practice Location Address
First Line	:	6224 HEARNE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-4322
Country	:	US
Telephone Number	:	318-525-0525
Fax Number	:	318-525-1272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN L. LAWRENCE
Credential	:	D.C.
Telephone Number	:	318-525-0525

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

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