Provider Demographics
NPI:1710175393
Name:CEDAR HILL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CEDAR HILL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAVIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-274-5500
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:6734 MALL DR
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-0021
Mailing Address - Country:US
Mailing Address - Phone:636-274-5500
Mailing Address - Fax:636-285-0644
Practice Address - Street 1:6734 MALL DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016-2200
Practice Address - Country:US
Practice Address - Phone:636-274-5500
Practice Address - Fax:636-285-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000147044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty