Provider Demographics
NPI:1659440600
Name:LASSITER, LAURA M (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:LASSITER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:LASSITER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:834 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2027
Mailing Address - Country:US
Mailing Address - Phone:563-223-8343
Mailing Address - Fax:
Practice Address - Street 1:575 10TH ST SW STE 5
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3906
Practice Address - Country:US
Practice Address - Phone:563-223-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19601Medicare PIN
IAI19601Medicare PIN