Provider Demographics
NPI:1881468825
Name:LB CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:LB CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BREMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-370-9972
Mailing Address - Street 1:14323 SOUTH OUTER 40 RD STE 205S
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5742
Mailing Address - Country:US
Mailing Address - Phone:314-370-9972
Mailing Address - Fax:
Practice Address - Street 1:14323 SOUTH OUTER 40 RD STE 205S
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-5742
Practice Address - Country:US
Practice Address - Phone:314-370-9972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty