Healthcare Provider Details

I. General information

NPI: 1609815588
Provider Name (Legal Business Name): LAVALLEE CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 LEIGHTON RD
AUGUSTA ME
04330-7809
US

IV. Provider business mailing address

619 LEIGHTON RD
AUGUSTA ME
04330-7809
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-1111
  • Fax: 207-623-9990
Mailing address:
  • Phone: 207-623-1111
  • Fax: 207-623-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR 1402
License Number StateME

VIII. Authorized Official

Name: DR. JAMES RONALD LAVALLEE
Title or Position: CEO
Credential: D.C.
Phone: 207-623-1111