Provider Demographics
NPI:1700859675
Name:GAUTHIER, ANNE-LAURE (DC)
Entity Type:Individual
Prefix:
First Name:ANNE-LAURE
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 N STATE ROUTE 9
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3549
Mailing Address - Country:US
Mailing Address - Phone:816-741-9232
Mailing Address - Fax:816-741-3118
Practice Address - Street 1:6008 N STATE ROUTE 9
Practice Address - Street 2:SUITE A
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3549
Practice Address - Country:US
Practice Address - Phone:816-741-9232
Practice Address - Fax:816-741-3118
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU76616Medicare UPIN
MON75A125Medicare ID - Type Unspecified