Healthcare Provider Details

I. General information

NPI: 1801193149
Provider Name (Legal Business Name): GATEWAY 2 HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 CHESTERFIELD MALL
CHESTERFIELD MO
63017-4807
US

IV. Provider business mailing address

91 CHESTERFIELD MALL
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 636-346-1395
  • Fax: 636-536-0828
Mailing address:
  • Phone: 636-346-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2011001253
License Number StateMO

VIII. Authorized Official

Name: DR. JON R PINKSTON
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 636-346-1395