Provider Demographics
NPI:1255632238
Name:LOFQUIST, LORENELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LORENELLE
Middle Name:
Last Name:LOFQUIST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LORIE
Other - Middle Name:
Other - Last Name:LOFQUIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1747 SMIZER STATION RD
Mailing Address - Street 2:STE 4
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2784
Mailing Address - Country:US
Mailing Address - Phone:636-825-6555
Mailing Address - Fax:636-825-6546
Practice Address - Street 1:1747 SMIZER STATION RD
Practice Address - Street 2:STE 4
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2784
Practice Address - Country:US
Practice Address - Phone:636-825-6555
Practice Address - Fax:636-825-6545
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011012193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor