MEDICARE: DR. MICHAEL SCOTT UNNERSTALL DC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	006570	MO

General Provider Information

NPI Number	:	1043210222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT UNNERSTALL DC

Provider Business Mailing Address
First Line	:	1503 ZERO AVE
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-4714
Country	:	US
Telephone Number	:	636-239-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	15945 CLAYTON RD STE 230C
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2491
Country	:	US
Telephone Number	:	636-256-5200
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/05/2023

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