Provider Demographics
NPI:1144221748
Name:LASSITER, JONATHAN TRELLIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TRELLIS
Last Name:LASSITER
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 1:1305 PICKWICK ST S
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-3506
Mailing Address - Country:US
Mailing Address - Phone:731-925-4251
Mailing Address - Fax:731-925-1664
Practice Address - Street 1:1305 PICKWICK ST S
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3506
Practice Address - Country:US
Practice Address - Phone:731-925-4251
Practice Address - Fax:731-925-1664
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3014849OtherBCBS OF TN
TNU56844Medicare UPIN
TN3677924Medicare ID - Type Unspecified