MEDICARE: AFFTON LEMAY CHIROPRACTIC CENTER LLC

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	005518	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350046064	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33695	OTHER	MO	GROUP HEALTH PLAN
3	7788	OTHER	MO	BLUE CROSS BLUE SHIELD
4	119883	OTHER	MO	ANTHEM BLUE CROSS BLUE SHIELD
5	4406970	OTHER	MO	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1205000106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFTON LEMAY CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	4006 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1314
Country	:	US
Telephone Number	:	314-631-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1314
Country	:	US
Telephone Number	:	314-631-5550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD ALLEN HENGEL
Credential	:	DC
Telephone Number	:	314-631-5550

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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Practice Location Address:

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1609565746 — DR. JESSICA SUSAN FERGUSON DC
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1144244930 — DR. ADRIAN M. DI BISCEGLIE M.D.
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1538329735 — MS. JENNIFER LYNNE DIZES RN
Practice Location Address:

3545 LAFAYETTE AVE , SALUS CENTER 2ND FLOOR
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Practice Location Address:

3545 LAFAYETTE AVE , SUITE 400
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1689060840 — DR. CARL GRIFFIN TROTTER M.D.
Practice Location Address:

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Directions to “AFFTON LEMAY CHIROPRACTIC CENTER LLC ” Practice Location

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