Provider Demographics
NPI:1700067410
Name:LAGONI, FRANK J JR (DC)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:LAGONI
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 S STATE ROAD 67
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9489
Mailing Address - Country:US
Mailing Address - Phone:765-778-4095
Mailing Address - Fax:
Practice Address - Street 1:6535 S STATE ROAD 67
Practice Address - Street 2:SUITE 200
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9489
Practice Address - Country:US
Practice Address - Phone:765-778-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002337A111N00000X
KY4969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200879780Medicaid
IN200879780Medicaid