Provider Demographics
NPI:1083707129
Name:LALAMA CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:LALAMA CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-793-5555
Mailing Address - Street 1:134 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-793-5555
Mailing Address - Fax:330-793-7649
Practice Address - Street 1:134 WESTCHESTER DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-793-5555
Practice Address - Fax:330-793-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0729091Medicaid
OH0729091Medicaid