Provider Demographics
NPI:1154093151
Name:LAKE SAINT LOUIS CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:LAKE SAINT LOUIS CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-265-1116
Mailing Address - Street 1:910 BENT OAK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1473
Mailing Address - Country:US
Mailing Address - Phone:636-265-1116
Mailing Address - Fax:866-519-5622
Practice Address - Street 1:910 BENT OAK CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1473
Practice Address - Country:US
Practice Address - Phone:636-265-1116
Practice Address - Fax:866-519-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty