Provider Demographics
NPI:1871863936
Name:LAFAYETTE CHIROPRACTIC
Entity Type:Organization
Organization Name:LAFAYETTE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-501-4691
Mailing Address - Street 1:10 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-2021
Mailing Address - Country:US
Mailing Address - Phone:334-459-0202
Mailing Address - Fax:334-459-0202
Practice Address - Street 1:10 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:AL
Practice Address - Zip Code:36862-2021
Practice Address - Country:US
Practice Address - Phone:334-459-0202
Practice Address - Fax:334-545-9020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUBURN CHIROPRACTIC HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51006446OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL1401Medicare PIN