Provider Demographics
NPI:1386037745
Name:LASCOTTE, MARK JR (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LASCOTTE
Suffix:JR
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 1:4480 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2357
Mailing Address - Country:US
Mailing Address - Phone:651-209-9906
Mailing Address - Fax:651-209-9909
Practice Address - Street 1:4480 ERIN DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2357
Practice Address - Country:US
Practice Address - Phone:651-209-9906
Practice Address - Fax:651-209-9909
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor