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NPI Code Detail

MEDICARE: ESQUIRE SPORTS MEDICINE SOUTH

MEDICARE: ESQUIRE SPORTS MEDICINE SOUTH
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
1111N00000XChiropractor005985MO

General Provider Information

NPI Number : 1720035405
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESQUIRE SPORTS MEDICINE SOUTH
Provider Business Mailing Address
First Line : 11133 LINDBERGH BUS
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-7810
Country : US
Telephone Number : 314-416-1960
Fax Number :
Provider Business Practice Location Address
First Line : 11133 LINDBERGH BUS
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-7810
Country : US
Telephone Number : 314-416-1960
Fax Number :
Authorized Official
Title or Position : OWNER
Name : THOMAS DAVIS
Credential : DC
Telephone Number : 314-416-1690
Provider Enumeration Date : 05/28/2006
Last Update Date : 08/11/2008

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Directions to “ESQUIRE SPORTS MEDICINE SOUTH ” Practice Location

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