Provider Demographics
NPI:1477837391
Name:LASTINE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LASTINE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:LASTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-537-1475
Mailing Address - Street 1:1411 E COLLEGE DR
Mailing Address - Street 2:STE 4
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2086
Mailing Address - Country:US
Mailing Address - Phone:507-537-1475
Mailing Address - Fax:507-537-9498
Practice Address - Street 1:1411 E COLLEGE DR
Practice Address - Street 2:STE 4
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2086
Practice Address - Country:US
Practice Address - Phone:507-537-1475
Practice Address - Fax:507-537-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN891228900Medicaid
MN350001880Medicare UPIN