Provider Demographics
NPI:1316036122
Name:LAFONTAINE, DANIEL LEONARD (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEONARD
Last Name:LAFONTAINE
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 1:411 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-8186
Mailing Address - Country:US
Mailing Address - Phone:714-960-7807
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-8186
Practice Address - Country:US
Practice Address - Phone:714-960-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor