Provider Demographics
NPI:1760496251
Name:LAJEUNESSE, MARK ANDRE (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDRE
Last Name:LAJEUNESSE
Suffix:
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 1:211 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1540
Mailing Address - Country:US
Mailing Address - Phone:660-269-9886
Mailing Address - Fax:660-269-8956
Practice Address - Street 1:211 N CLARK ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1540
Practice Address - Country:US
Practice Address - Phone:660-269-9886
Practice Address - Fax:660-269-8956
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor