Provider Demographics
NPI:1811129836
Name:LAUGHTON CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:LAUGHTON CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-649-6942
Mailing Address - Street 1:417 EAST MAIN ST
Mailing Address - Street 2:PO BOX 663
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853
Mailing Address - Country:US
Mailing Address - Phone:217-586-7000
Mailing Address - Fax:217-586-7007
Practice Address - Street 1:417 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853
Practice Address - Country:US
Practice Address - Phone:217-649-6942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty