=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083707129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LALAMA CHIROPRACTIC CLINIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 WESTCHESTER DRIVE SUITE 4
-----------------------------------------------------
City | AUSTINTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-793-5555
-----------------------------------------------------
Fax | 330-793-7649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 WESTCHESTER DRIVE SUITE 4
-----------------------------------------------------
City | AUSTINTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-793-5555
-----------------------------------------------------
Fax | 330-793-7649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PATRICK ANTHONY LALAMA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-793-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1327
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------