MEDICARE: TOMASITA ALICIA LAHUE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	111N00000X	Chiropractor	IL
2	111NN1001X	Nutrition Chiropractor	IL
3	111NR0400X	Rehabilitation Chiropractor	IL

General Provider Information

NPI Number	:	1598834970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMASITA ALICIA LAHUE D.C.

Provider Business Mailing Address
First Line	:	4965 STONE FALLS CTR
Second Line	:	SUITE #7
City	:	O FALLON
State	:	IL
Zip	:	62269-7802
Country	:	US
Telephone Number	:	618-624-9384
Fax Number	:	618-624-9386

Provider Business Practice Location Address
First Line	:	4965 STONE FALLS CTR
Second Line	:	SUITE #7
City	:	O FALLON
State	:	IL
Zip	:	62269-7802
Country	:	US
Telephone Number	:	618-624-9384
Fax Number	:	618-624-9386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/11/2025

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