Provider Demographics
NPI:1922667724
Name:ROBINSON, LASHASTA (DC)
Entity Type:Individual
Prefix:DR
First Name:LASHASTA
Middle Name:
Last Name:ROBINSON
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 1:2601 BEMISS RD STE Q
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1450
Mailing Address - Country:US
Mailing Address - Phone:229-474-4069
Mailing Address - Fax:229-474-4482
Practice Address - Street 1:2601 BEMISS RD STE Q
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1450
Practice Address - Country:US
Practice Address - Phone:229-474-4069
Practice Address - Fax:229-474-4482
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO009758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0OtherPENDING