Provider Demographics
NPI:1609815588
Name:LAVALLEE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LAVALLEE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:LAVALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-623-1111
Mailing Address - Street 1:619 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7809
Mailing Address - Country:US
Mailing Address - Phone:207-623-1111
Mailing Address - Fax:207-623-9990
Practice Address - Street 1:619 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7809
Practice Address - Country:US
Practice Address - Phone:207-623-1111
Practice Address - Fax:207-623-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR 1402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME422800000Medicaid
ME422800000Medicaid