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General NPI Number Information
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NPI Number | 1477859775
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Entity Type | Individual
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Provider Name | BRAD LACROIX
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Gender | Male
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 287 FALL ST
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City | SENECA FALLS
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State | NY
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Zip | 13148-1516
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Country | US
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Telephone | 315-745-0702
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Fax |
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Provider Business Mailing Address
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Address Line | 287 FALL ST
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City | SENECA FALLS
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State | NY
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Zip | 13148-1516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | NOT AVAILABLE
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License Number State | NY
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