Provider Demographics
NPI:1104900703
Name:LAVIN, CARL E (DC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:LAVIN
Suffix:
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 1:1911 OLD HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-7015
Mailing Address - Country:US
Mailing Address - Phone:804-794-8513
Mailing Address - Fax:
Practice Address - Street 1:13700 GENITO RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4007
Practice Address - Country:US
Practice Address - Phone:804-744-8710
Practice Address - Fax:804-744-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-002022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA272807OtherBLUE CROSS BLUE SHIELD