Provider Demographics
NPI:1700933926
Name:LAFFERTY, EDWARD T III (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:LAFFERTY
Suffix:III
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 1:103 4TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2449
Mailing Address - Country:US
Mailing Address - Phone:721-645-1623
Mailing Address - Fax:
Practice Address - Street 1:103 4TH ST STE 330
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2449
Practice Address - Country:US
Practice Address - Phone:721-645-1623
Practice Address - Fax:732-901-5044
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00608500111N00000X
COCHR.0008110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR.0008110OtherCOLORADO CHIROPRACTIC LICENSE
COEL.2787047OtherCOLORADO ELECTROTHERAPY CHIROPRACTIC LICENSE