Provider Demographics
NPI:1992740005
Name:LAFORGE, SHALOM M (DC)
Entity type:Individual
Prefix:DR
First Name:SHALOM
Middle Name:M
Last Name:LAFORGE
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 1:2243 S MERIDIAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-1911
Mailing Address - Country:US
Mailing Address - Phone:316-945-2525
Mailing Address - Fax:316-945-5694
Practice Address - Street 1:2243 S MERIDIAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-1911
Practice Address - Country:US
Practice Address - Phone:316-945-2525
Practice Address - Fax:316-945-5694
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS01-04896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS8789OtherPHS
KS062167OtherBLUE CROSS BLUE SHIELD
KS062167Medicare ID - Type Unspecified
KSV03411Medicare UPIN