Provider Demographics
NPI:1164662391
Name:MARK F. LAVALLIE, D.C.
Entity Type:Organization
Organization Name:MARK F. LAVALLIE, D.C.
Other - Org Name:BATTLE CREEK CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAVALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-714-4848
Mailing Address - Street 1:261 RUTH ST N STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4337
Mailing Address - Country:US
Mailing Address - Phone:651-714-4848
Mailing Address - Fax:651-739-8452
Practice Address - Street 1:261 RUTH ST N STE 108
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4337
Practice Address - Country:US
Practice Address - Phone:651-714-4848
Practice Address - Fax:651-739-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003775Medicare PIN