Provider Demographics
NPI:1205258621
Name:DONAKER, TOBIAS (LAC)
Entity type:Individual
Prefix:
First Name:TOBIAS
Middle Name:
Last Name:DONAKER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3717
Mailing Address - Country:US
Mailing Address - Phone:314-772-4325
Mailing Address - Fax:855-774-8507
Practice Address - Street 1:2006 S 39TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3717
Practice Address - Country:US
Practice Address - Phone:314-772-4325
Practice Address - Fax:855-774-8507
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016039740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist