Provider Demographics
NPI:1366951949
Name:LAVALLIE, NATALIA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:ELIZABETH
Last Name:LAVALLIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5535
Mailing Address - Country:US
Mailing Address - Phone:630-394-4228
Mailing Address - Fax:847-512-4675
Practice Address - Street 1:240 W RIVER DR
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5535
Practice Address - Country:US
Practice Address - Phone:630-394-4228
Practice Address - Fax:847-512-4675
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor