Healthcare Provider Details

I. General information

NPI: 1194018408
Provider Name (Legal Business Name): SPORTS & FAMILY CHIROPRACTIC & ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CHESTERFIELD COMMONS RD E
CHESTERFIELD MO
63005-1440
US

IV. Provider business mailing address

10510 OLD OLIVE STREET RD
CREVE COEUR MO
63141-5926
US

V. Phone/Fax

Practice location:
  • Phone: 636-530-1212
  • Fax:
Mailing address:
  • Phone: 314-991-2295
  • Fax: 314-991-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2007000313
License Number StateMO

VIII. Authorized Official

Name: DR. JOSHUA A KILPATRICK
Title or Position: OWNER/ PRESIDENT
Credential: DC
Phone: 636-530-1212