MEDICARE: ERIV A NEPUTE DC 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	2007000308	MO

General Provider Information

NPI Number	:	1750594552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIV A NEPUTE DC LLC

Provider Business Mailing Address
First Line	:	110 E 1ST NORTH ST
Second Line	:
City	:	CARLINVILLE
State	:	IL
Zip	:	62626-1505
Country	:	US
Telephone Number	:	217-854-3300
Fax Number	:	217-854-4546

Provider Business Practice Location Address
First Line	:	4225 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-544-5600
Fax Number	:	314-544-5696

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAMON P WALTON
Credential	:	DC
Telephone Number	:	217-854-3300

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	09/05/2008

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