Basic Information
Provider Information
NPI: 1972543528
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAWRENCE
FirstName: ROBERT
MiddleName: CORY
NamePrefix:  
NameSuffix:  
Credential: LAC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 166
Address2:  
City: PITTSBORO
State: NC
PostalCode: 273120166
CountryCode: US
TelephoneNumber: 9199327266
FaxNumber: 9199327250
Practice Location
Address1: 77 S ELLIOTT RD
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275145827
CountryCode: US
TelephoneNumber: 9199327266
FaxNumber: 9199327250
Other Information
ProviderEnumerationDate: 06/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X248NCY Other Service ProvidersAcupuncturist 

No ID Information.


Home