Provider Demographics
NPI:1164538385
Name:LAVIGNE, SHAWN D (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:LAVIGNE
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 21
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-0021
Mailing Address - Country:US
Mailing Address - Phone:636-274-5500
Mailing Address - Fax:636-285-0644
Practice Address - Street 1:6734 MALL DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016-2200
Practice Address - Country:US
Practice Address - Phone:636-274-5500
Practice Address - Fax:636-285-0644
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000147044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000032234Medicare ID - Type Unspecified
MOU82559Medicare UPIN