MEDICARE: ADVANCED WELLNESS CHIROPRACTIC 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

General Provider Information

NPI Number	:	1861901761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WELLNESS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	11520 SAINT CHARLES ROCK RD STE 104
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2732
Country	:	US
Telephone Number	:	314-393-5391
Fax Number	:

Provider Business Practice Location Address
First Line	:	11520 SAINT CHARLES ROCK RD STE 104
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2732
Country	:	US
Telephone Number	:	314-393-5391
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JE'AN-CLAUDE DALTON BORDEAUX
Credential	:	DC
Telephone Number	:	314-393-5391

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	03/21/2026

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Directions to “ADVANCED WELLNESS CHIROPRACTIC LLC ” Practice Location

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