Healthcare Provider Details

I. General information

NPI: 1649622499
Provider Name (Legal Business Name): HEALTH WEBB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 WISHWOOD CT APT 2
CHESTERFIELD MO
63017-8527
US

IV. Provider business mailing address

1651 WISHWOOD CT APT 2
CHESTERFIELD MO
63017-8527
US

V. Phone/Fax

Practice location:
  • Phone: 636-728-9113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2016022433
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2016022433
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2016022433
License Number StateMO

VIII. Authorized Official

Name: RAQUEL L GROGAN-WEBB
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 636-728-9113