Provider Demographics
NPI:1093105439
Name:LAVIGNE, KAITLIN (DC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 W 80TH ST APT 21
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4719
Mailing Address - Country:US
Mailing Address - Phone:913-957-7234
Mailing Address - Fax:
Practice Address - Street 1:10000 W 75TH ST STE 117
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2241
Practice Address - Country:US
Practice Address - Phone:913-223-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor