Healthcare Provider Details

I. General information

NPI: 1598834970
Provider Name (Legal Business Name): TOMASITA ALICIA LAHUE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4965 STONE FALLS CTR SUITE #7
O FALLON IL
62269-7802
US

IV. Provider business mailing address

4965 STONE FALLS CTR SUITE #7
O FALLON IL
62269-7802
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-9384
  • Fax: 618-624-9386
Mailing address:
  • Phone: 618-624-9384
  • Fax: 618-624-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: