Healthcare Provider Details

I. General information

NPI: 1053515957
Provider Name (Legal Business Name): DYNAMIC HEALTH CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BAXTER RD SUITE #8
CHESTERFIELD MO
63017-7032
US

IV. Provider business mailing address

510 BAXTER RD SUITE #8
CHESTERFIELD MO
63017-7032
US

V. Phone/Fax

Practice location:
  • Phone: 636-207-6600
  • Fax: 636-207-6631
Mailing address:
  • Phone: 636-207-6600
  • Fax: 636-207-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2001011188
License Number StateMO

VIII. Authorized Official

Name: DR. JENNIFER CHRISTINE KANE
Title or Position: MEMBER/MANAGER
Credential: D.C.
Phone: 314-496-8044