Provider Demographics
NPI:1083719447
Name:LAFAYETTE SQUARE CHIROPRACTIC CENTRE, LLC
Entity Type:Organization
Organization Name:LAFAYETTE SQUARE CHIROPRACTIC CENTRE, LLC
Other - Org Name:LAFAYETTE SQUARE CHIROPRACTIC CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEAIRS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-497-5507
Mailing Address - Street 1:1013 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2909
Mailing Address - Country:US
Mailing Address - Phone:314-436-3050
Mailing Address - Fax:314-499-8310
Practice Address - Street 1:1013 S 18TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2909
Practice Address - Country:US
Practice Address - Phone:314-497-5507
Practice Address - Fax:314-499-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20004024604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty