Provider Demographics
NPI:1598834970
Name:LAHUE, TOMASITA ALICIA (DC)
Entity type:Individual
Prefix:
First Name:TOMASITA
Middle Name:ALICIA
Last Name:LAHUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 STONE FALLS CTR
Mailing Address - Street 2:SUITE #7
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7802
Mailing Address - Country:US
Mailing Address - Phone:618-624-9384
Mailing Address - Fax:618-624-9386
Practice Address - Street 1:4965 STONE FALLS CTR
Practice Address - Street 2:SUITE #7
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-7802
Practice Address - Country:US
Practice Address - Phone:618-624-9384
Practice Address - Fax:618-624-9386
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13171Medicare UPIN