Provider Demographics
NPI:1649224221
Name:LORI LAMITINA, D.C., P.A.
Entity Type:Organization
Organization Name:LORI LAMITINA, D.C., P.A.
Other - Org Name:WHOLE HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LAMITINA
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-664-6664
Mailing Address - Street 1:P.O. BOX 250225
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225
Mailing Address - Country:US
Mailing Address - Phone:501-664-6664
Mailing Address - Fax:501-664-6614
Practice Address - Street 1:1405 N PIERCE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5349
Practice Address - Country:US
Practice Address - Phone:501-664-6664
Practice Address - Fax:501-664-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84172Medicare UPIN
5W272Medicare ID - Type Unspecified