=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649224221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORI LAMITINA, D.C., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 01/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 N PIERCE ST SUITE 210
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72207-5349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-6664
-----------------------------------------------------
Fax | 501-664-6614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 250225
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-6664
-----------------------------------------------------
Fax | 501-664-6614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | LORI LAMITINA NICHOLSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 501-664-6664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1550
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------