Healthcare Provider Details

I. General information

NPI: 1518384163
Provider Name (Legal Business Name): EDMISTONE ACUPUNCTURE & CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 THOUVENOT LN STE 300
O FALLON IL
62269-8916
US

IV. Provider business mailing address

1207 THOUVENOT LN STE 300
O FALLON IL
62269-8916
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-8080
  • Fax: 618-206-8070
Mailing address:
  • Phone: 618-624-8080
  • Fax: 618-206-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number03801464
License Number StateIL

VIII. Authorized Official

Name: MR. RONALD ALLEN EDMISTON
Title or Position: OWNER
Credential: D.C.
Phone: 618-624-8080