Healthcare Provider Details

I. General information

NPI: 1821090176
Provider Name (Legal Business Name): CHRISTOPHER LEE LAVOIE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

IV. Provider business mailing address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

V. Phone/Fax

Practice location:
  • Phone: 860-257-8700
  • Fax: 860-257-8720
Mailing address:
  • Phone: 860-257-8700
  • Fax: 860-257-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: