Provider Demographics
NPI:1073667838
Name:LASCO, RONNIE A (DC)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:A
Last Name:LASCO
Suffix:
Gender:M
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:PO BOX 1242
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-1242
Mailing Address - Country:US
Mailing Address - Phone:307-324-2872
Mailing Address - Fax:307-328-1665
Practice Address - Street 1:1812 DALEY ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5912
Practice Address - Country:US
Practice Address - Phone:307-324-2872
Practice Address - Fax:307-328-1665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY302575OtherBC-
WY302575OtherBC-
WY4670225Medicare PIN