Provider Demographics
NPI:1285791004
Name:DR LAURIE JAHNKE DC LLC
Entity type:Organization
Organization Name:DR LAURIE JAHNKE DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-236-4786
Mailing Address - Street 1:2303 WESCREEK DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4111
Mailing Address - Country:US
Mailing Address - Phone:636-236-4786
Mailing Address - Fax:
Practice Address - Street 1:2303 WESCREEK DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4111
Practice Address - Country:US
Practice Address - Phone:636-236-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty