Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 789 | MA |
NPI | 1003960865 |
---|---|
Provider Name | Dr. Kevin James Lalonde |
First Address | Duxbury, MA 02332-5304 |
Second Address | Duxbury, MA 02332-5304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1603809 | (05) | MA |
T58326 | (02) | MA |