Provider Demographics
NPI:1306858279
Name:LASTOFSKY, DARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:
Last Name:LASTOFSKY
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 1:5315 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3353
Mailing Address - Country:US
Mailing Address - Phone:561-434-4900
Mailing Address - Fax:561-434-4934
Practice Address - Street 1:5315 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3353
Practice Address - Country:US
Practice Address - Phone:561-434-4900
Practice Address - Fax:561-434-4934
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3805140-00Medicaid
FL22901Medicare ID - Type Unspecified