Provider Demographics
NPI:1538496146
Name:FONTAINE, LAUREN A (DC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:A
Last Name:FONTAINE
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 1:643 GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4819
Mailing Address - Country:US
Mailing Address - Phone:828-355-9052
Mailing Address - Fax:828-355-9047
Practice Address - Street 1:643 GREENWAY RD
Practice Address - Street 2:SUITE J3
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4819
Practice Address - Country:US
Practice Address - Phone:828-355-9052
Practice Address - Fax:828-355-9047
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor