Provider Demographics
NPI:1124095898
Name:LASTER, KEVIN C (DC OF CHIROPRATIC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:LASTER
Suffix:
Gender:M
Credentials:DC OF CHIROPRATIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 FAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-2304
Mailing Address - Country:US
Mailing Address - Phone:724-929-6077
Mailing Address - Fax:724-929-9410
Practice Address - Street 1:1100 FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-2304
Practice Address - Country:US
Practice Address - Phone:724-929-6077
Practice Address - Fax:724-929-9410
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004048L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA561207OtherHIGHMARK
PA561207OtherHIGHMARK
PAU24937Medicare UPIN