Provider Demographics
NPI:1689743114
Name:TISCH, LOUIS LEMOINE JR (DC)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:LEMOINE
Last Name:TISCH
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 1:307 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2457
Mailing Address - Country:US
Mailing Address - Phone:573-642-4387
Mailing Address - Fax:
Practice Address - Street 1:307 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2457
Practice Address - Country:US
Practice Address - Phone:573-642-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T43140Medicare PIN