Organization
LAKE ST. LOUIS CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON C FOWLER DC (OWNER)
(636) 887-9003
Entity
Organization
Contact information
Practice address
2161 WEST TERRA LANE, OFALLON, MO 63366-2366
(636) 887-9003
(636) 327-6090
Mailing address
2161 WEST TERRA LANE, OFALLON, MO 63366-2366
(636) 887-9003
(636) 327-6090
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2007032057
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D00754
RR MEDICARE
MO
01
—
PENDING
BCBS
—
Enumeration date
12/27/2007
Last updated
02/04/2009
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