Provider Demographics
NPI:1619115854
Name:LAVALLIERE, KEITH P (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:P
Last Name:LAVALLIERE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 101
Mailing Address - Street 2:UNIT # 7
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5030
Mailing Address - Country:US
Mailing Address - Phone:603-647-0600
Mailing Address - Fax:603-647-0633
Practice Address - Street 1:360 ROUTE 101
Practice Address - Street 2:UNIT # 7
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5030
Practice Address - Country:US
Practice Address - Phone:603-647-0600
Practice Address - Fax:603-647-0633
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8260908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor