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General NPI Number Information
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NPI Number | 1518094200
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Entity Type | Organization
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Legal Business Name | THOMAS M. LAFOUNTAIN CHIROPRACTIC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 130 LOMOND CT
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City | UTICA
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State | NY
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Zip | 13502-5951
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Country | US
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Telephone | 315-732-3400
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Fax | 315-732-4250
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Provider Business Mailing Address
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Address Line | 130 LOMOND CT
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City | UTICA
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State | NY
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Zip | 13502-5951
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Country | US
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Telephone | 315-732-3400
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Fax | 315-732-4250
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | THOMAS MICHAEL LAFOUNTAIN
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Credential | D.C.
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Telephone | 315-732-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | X003195
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License Number State | NY
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