Healthcare Provider Details

I. General information

NPI: 1992724207
Provider Name (Legal Business Name): THOMAS MICHAEL LAFOUNTAIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LOMOND CT
UTICA NY
13502-5951
US

IV. Provider business mailing address

130 LOMOND CT
UTICA NY
13502-5951
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-3400
  • Fax: 315-732-4250
Mailing address:
  • Phone: 315-732-3400
  • Fax: 315-732-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX003195
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX003195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: