Provider Demographics
NPI:1609830314
Name:LAFFOON CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LAFFOON CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LAFFOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-864-8806
Mailing Address - Street 1:7720 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2773
Mailing Address - Country:US
Mailing Address - Phone:724-864-8806
Mailing Address - Fax:724-864-8807
Practice Address - Street 1:7720 ROUTE 30
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2773
Practice Address - Country:US
Practice Address - Phone:724-864-8806
Practice Address - Fax:724-864-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004798-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235136847OtherNPI FOR INDIVIDUAL DR.
PA715362Medicare ID - Type UnspecifiedMEDICARE ID