Healthcare Provider Details

I. General information

NPI: 1700163508
Provider Name (Legal Business Name): CLAIRE S LAVAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 SUGARLOAF PKWY STE 115
LAWRENCEVILLE GA
30045-9402
US

IV. Provider business mailing address

1960 SPECTRUM CIR SE APT 235
MARIETTA GA
30067-1661
US

V. Phone/Fax

Practice location:
  • Phone: 678-883-3218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHIRO09081
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIRO09081
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIRO09081
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIRO09081
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIRO09081
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIRO09081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: