Provider Demographics
NPI:1053404616
Name:LINGAFELTER, TOBIN (DC)
Entity type:Individual
Prefix:
First Name:TOBIN
Middle Name:
Last Name:LINGAFELTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1366
Mailing Address - Country:US
Mailing Address - Phone:314-842-8884
Mailing Address - Fax:314-842-9884
Practice Address - Street 1:3828 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1366
Practice Address - Country:US
Practice Address - Phone:314-842-8884
Practice Address - Fax:314-842-9884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004 004128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO673239OtherHEALTHLINK
MO190432OtherBLUECROSS BLUESHIELD
MO190432OtherBLUECROSS BLUESHIELD