Healthcare Provider Details

I. General information

NPI: 1982760377
Provider Name (Legal Business Name): BRYAN MATTHEW RASCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3452 MCKELVEY RD
BRIDGETON MO
63044-2533
US

IV. Provider business mailing address

550 SCHRADER FARM DR
SAINT PETERS MO
63376-4527
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-8841
  • Fax: 314-739-6043
Mailing address:
  • Phone: 314-739-8841
  • Fax: 314-739-6043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2002010529
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: