Provider Demographics
NPI:1639327109
Name:LAFONTAINE, SHANTEL ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANTEL
Middle Name:ROSE
Last Name:LAFONTAINE
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 1:5616 LANDRUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8893
Mailing Address - Country:US
Mailing Address - Phone:404-918-3650
Mailing Address - Fax:
Practice Address - Street 1:2175 CHAMBLISS AVE. NE
Practice Address - Street 2:STE D
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-472-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006886111N00000X
TNDC0000002461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor