Healthcare Provider Details

I. General information

NPI: 1235136847
Provider Name (Legal Business Name): ELTON B LAFFOON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 ROUTE 30
NORTH HUNTINGDON PA
15642-2773
US

IV. Provider business mailing address

7720 ROUTE 30
NORTH HUNTINGDON PA
15642-2773
US

V. Phone/Fax

Practice location:
  • Phone: 724-864-8806
  • Fax: 724-864-8807
Mailing address:
  • Phone: 724-864-8806
  • Fax: 724-864-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004798L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: