Healthcare Provider Details

I. General information

NPI: 1346370228
Provider Name (Legal Business Name): LORI ALLISON CRAVIOTTO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W. HWY 246
BUELLTON CA
93427
US

IV. Provider business mailing address

PO BOX 575 90 W. HWY 246
BUELLTON CA
93427-0575
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-5545
  • Fax: 805-688-5676
Mailing address:
  • Phone: 805-688-5545
  • Fax: 805-688-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 17658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: