Provider Demographics
NPI:1023335940
Name:LAFAVOR, ELISA HELEN (DC)
Entity type:Individual
Prefix:MISS
First Name:ELISA
Middle Name:HELEN
Last Name:LAFAVOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2934 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1027
Mailing Address - Country:US
Mailing Address - Phone:860-659-8279
Mailing Address - Fax:860-633-7252
Practice Address - Street 1:702 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4951
Practice Address - Country:US
Practice Address - Phone:561-693-2755
Practice Address - Fax:561-693-2797
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor