Healthcare Provider Details

I. General information

NPI: 1790080778
Provider Name (Legal Business Name): MICHELLE LAFONTAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 RAINIER AVE S
SEATTLE WA
98144-5349
US

IV. Provider business mailing address

2326 RAINIER AVE S STE B
SEATTLE WA
98144-5349
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-3040
  • Fax: 206-329-3041
Mailing address:
  • Phone: 206-329-3040
  • Fax: 206-329-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMA60199615
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60199615
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: