Provider Demographics
NPI:1700803434
Name:VELTE, LAUREL (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:VELTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-8970
Mailing Address - Country:US
Mailing Address - Phone:815-234-3021
Mailing Address - Fax:815-234-5580
Practice Address - Street 1:105 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-8970
Practice Address - Country:US
Practice Address - Phone:815-234-3021
Practice Address - Fax:815-234-5580
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7115575OtherBLUE CROSS BLUE SHIELD
IL380042230Medicaid
IL380042230Medicaid
IL392930Medicare ID - Type Unspecified