Provider Demographics
NPI:1497750491
Name:LAVALLEY, CHARLES W (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:LAVALLEY
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 1:4525 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3596
Mailing Address - Country:US
Mailing Address - Phone:785-215-8700
Mailing Address - Fax:785-215-8717
Practice Address - Street 1:4525 SW 21ST STREET
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3596
Practice Address - Country:US
Practice Address - Phone:785-272-4242
Practice Address - Fax:785-272-5623
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU22162Medicare UPIN
KS060063Medicare ID - Type Unspecified