NPI 1881961829

Chiropractic and Sports Rehab

Organisation Exclusive Provider Organization Hazelwood, MO

Practice location

Address: 320 Brookes Dr Suite 237, Hazelwood, MO 63042-2736
Phone: (314) 372-6702
Mailing address: PO Box 385, Saint Charles, MO 63302-0385

Authorised official

Name: Kristy Williams
Title: Owner
Phone: (314) 372-6702

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 2010040254 (MO)

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Registry record

NPI: 1881961829
Entity type: Organization
NPI issued: 18 Nov 2011
Record last updated: 18 Nov 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.