Provider Demographics
NPI:1588098149
Name:TIMOTHY LEE LASTER
Entity type:Organization
Organization Name:TIMOTHY LEE LASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-333-2983
Mailing Address - Street 1:1331 JEFFCO BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2165
Mailing Address - Country:US
Mailing Address - Phone:636-333-2983
Mailing Address - Fax:636-333-2985
Practice Address - Street 1:1331 JEFFCO BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2165
Practice Address - Country:US
Practice Address - Phone:636-333-2983
Practice Address - Fax:636-333-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty