Healthcare Provider Details

I. General information

NPI: 1801190293
Provider Name (Legal Business Name): SMART PAIN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2623
US

IV. Provider business mailing address

11901 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2623
US

V. Phone/Fax

Practice location:
  • Phone: 314-298-1400
  • Fax: 314-298-1401
Mailing address:
  • Phone: 314-298-1400
  • Fax: 314-298-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008027070
License Number StateMO

VIII. Authorized Official

Name: ROBERT F ANDEL III
Title or Position: OWNER
Credential:
Phone: 314-298-1400