Provider Demographics
NPI:1518786698
Name:ONE SOURCE CARE LLC
Entity type:Organization
Organization Name:ONE SOURCE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-215-9401
Mailing Address - Street 1:1704 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8011
Mailing Address - Country:US
Mailing Address - Phone:801-215-9401
Mailing Address - Fax:888-622-9950
Practice Address - Street 1:1972 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1459
Practice Address - Country:US
Practice Address - Phone:801-215-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty