Individual provider Active NPI

Mark F Lavallie, D.C., D.A.B.C.O.

  • Chiropractor
  • Saint Paul, MN
National Provider Identifier
1477581742
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
00-1753 Issued in MN
Practice address
261 Ruth St N
Saint Paul, MN 55119-4337
Phone
(651) 714-4848
Fax
(651) 739-8452
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 00-1753 MN Primary

Addresses

Primary practice location

261 Ruth St N
Saint Paul, MN 55119-4337

Mailing address

PO Box 280337
Saint Paul, MN 55128-9337
Phone (651) 432-3806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050315000468 MN Practitioner - Chiropractic 1850346685 Practice locations: Saint Paul, MN

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

261 Ruth St N
Saint Paul, MN 55119-4337
Phone (651) 714-4848

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
00-1753MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Belde Chiropractic Clinic, PA Chiropractor PastSince Nov 1, 2012 Accepting new patients
IHS of Woodbury, P.a. Chiropractor Past Accepting new patients
IHS Midwest PC Chiropractor PastSince Mar 1, 2011 Accepting new patients
Midway Healthcare Services PA Chiropractor Past Accepting new patients
Mark F. Lavallie, D.C. Chiropractor PastSince Nov 10, 2012 Accepting new patients
IHS of Woodbury PA Chiropractor Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477581742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280337",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551289337",
            "telephone_number": "651-432-3806",
            "fax_number": "651-739-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 RUTH ST N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194337",
            "telephone_number": "651-714-4848",
            "fax_number": "651-739-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVALLIE",
        "first_name": "MARK",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.C., D.A.B.C.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "00-1753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.