Provider Demographics
NPI:1194041889
Name:ST. LOUIS LASER LLC
Entity Type:Organization
Organization Name:ST. LOUIS LASER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:HAINZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-378-6071
Mailing Address - Street 1:16412 GREEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1850
Mailing Address - Country:US
Mailing Address - Phone:314-681-2800
Mailing Address - Fax:314-432-5088
Practice Address - Street 1:763 S NEW BALLAS RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-8704
Practice Address - Country:US
Practice Address - Phone:314-681-2800
Practice Address - Fax:314-432-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO005286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43538Medicare UPIN