Provider Demographics
NPI:1265898225
Name:MCINTYRE, LAUREN DANIELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:DANIELLE
Last Name:MCINTYRE
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 NESBIT DR STE D
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1347
Mailing Address - Country:US
Mailing Address - Phone:573-534-7070
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 176
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-0176
Practice Address - Country:US
Practice Address - Phone:573-534-7070
Practice Address - Fax:573-534-7071
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO81-1081422OtherTIN