1801056254 NPI number — LAFAYETTE CHIROPRACTIC PLLC

Table of content: (NPI 1801056254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801056254 NPI number — LAFAYETTE CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFAYETTE CHIROPRACTIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801056254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 321
Provider Second Line Business Mailing Address:
2471 ROUTE 11
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13084-0321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-677-0107
Provider Business Mailing Address Fax Number:
315-677-0107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2471 ROUTE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13084-0321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-677-0107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COTY
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-677-0107

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  79151 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)