Provider Demographics
NPI:1639480213
Name:LAGONI CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LAGONI CHIROPRACTIC LLC
Other - Org Name:LAGONI CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LAGONI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:765-778-4095
Mailing Address - Street 1:6535 S STATE ROAD 67
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9489
Mailing Address - Country:US
Mailing Address - Phone:765-778-4095
Mailing Address - Fax:765-778-0329
Practice Address - Street 1:6535 S STATE ROAD 67
Practice Address - Street 2:SUITE 200
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9489
Practice Address - Country:US
Practice Address - Phone:765-778-4095
Practice Address - Fax:765-778-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002337A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201011330AMedicaid
INM100019992Medicare PIN