Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | IL | |
N | 111NN1001X | Nutrition | IL | |
N | 111NR0400X | Rehabilitation Chiropractor | IL |
NPI | 1598834970 |
---|---|
Provider Name | Tomasita Alicia Lahue |
First Address | O Fallon, IL 62269-7802 |
Second Address | O Fallon, IL 62269-7802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K13171 | (02) | IL |