Healthcare Provider Details

I. General information

NPI: 1518094200
Provider Name (Legal Business Name): THOMAS M. LAFOUNTAIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
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 TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX003195
License Number StateNY

VIII. Authorized Official

Name: THOMAS MICHAEL LAFOUNTAIN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 315-732-3400