Provider Demographics
NPI:1114131372
Name:LATZER, JINTANA J (DC)
Entity Type:Individual
Prefix:DR
First Name:JINTANA
Middle Name:J
Last Name:LATZER
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 1:2821 N BALLAS RD
Mailing Address - Street 2:SUITE C5
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-432-7979
Mailing Address - Fax:314-432-7979
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:SUITE C5
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-432-7979
Practice Address - Fax:314-432-7979
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO139952OtherHEALTHLINK
MO2880OtherBCBS
U30240Medicare UPIN