1518094200 NPI number — THOMAS M. LAFOUNTAIN CHIROPRACTIC

Table of content: (NPI 1518094200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518094200 NPI number — THOMAS M. LAFOUNTAIN CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS M. LAFOUNTAIN CHIROPRACTIC
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:
1518094200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 LOMOND CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13502-5951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-732-3400
Provider Business Mailing Address Fax Number:
315-732-4250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 LOMOND CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13502-5951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-732-3400
Provider Business Practice Location Address Fax Number:
315-732-4250
Provider Enumeration Date:
02/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAFOUNTAIN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
315-732-3400

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  X003195 , 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)

  • Identifier: 0142707 . This is a "GHI PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1992724207 . This is a "NPI INDIVIDUAL IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10032541 . This is a "CDPHP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010003195 . This is a "BCBS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".