Provider Demographics
NPI:1174629851
Name:COLVIN, LAURENT LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURENT
Middle Name:LEWIS
Last Name:COLVIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 COWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4395
Mailing Address - Country:US
Mailing Address - Phone:530-400-5708
Mailing Address - Fax:866-692-0453
Practice Address - Street 1:4618 COWELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4395
Practice Address - Country:US
Practice Address - Phone:530-400-5708
Practice Address - Fax:866-692-0453
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28648111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0286480Medicare ID - Type Unspecified