Provider Demographics
NPI:1730228644
Name:LAWSON, WAYNE DAVID (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:DAVID
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 ELMWAY
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-9629
Mailing Address - Country:US
Mailing Address - Phone:509-422-4701
Mailing Address - Fax:
Practice Address - Street 1:2516 ELMWAY
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-9629
Practice Address - Country:US
Practice Address - Phone:509-422-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022465Medicaid
WAGAB08120Medicare ID - Type Unspecified
WAU74136Medicare UPIN