Provider Demographics
NPI:1922027614
Name:LAVOIE, CONNIE SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SUE
Last Name:LAVOIE
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 1:1900 MORMON MILL RD
Mailing Address - Street 2:STE F2
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4177
Mailing Address - Country:US
Mailing Address - Phone:830-613-2305
Mailing Address - Fax:830-798-9955
Practice Address - Street 1:1900 MORMON MILL RD
Practice Address - Street 2:STE F2
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4177
Practice Address - Country:US
Practice Address - Phone:830-613-2305
Practice Address - Fax:830-798-9955
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10127111N00000X
GA834111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
U22566Medicare UPIN