Healthcare Provider Details

I. General information

NPI: 1043539521
Provider Name (Legal Business Name): CHESTERFIELD TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 RD SUITE 365
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

14825 N OUTER 40 RD SUITE 365
CHESTERFIELD MO
63017-2152
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-2570
  • Fax: 314-336-2571
Mailing address:
  • Phone: 314-336-2570
  • Fax: 314-336-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number2009025407
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN SCHRANCK SR.
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 314-336-2570