Healthcare Provider Details

I. General information

NPI: 1154352094
Provider Name (Legal Business Name): SCOTT HAINZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 S NEW BALLAS RD SUITE 230
CREVE COEUR MO
63141-8704
US

IV. Provider business mailing address

16412 GREEN PINES DR
WILDWOOD MO
63011-1850
US

V. Phone/Fax

Practice location:
  • Phone: 314-681-2800
  • Fax: 314-432-5088
Mailing address:
  • Phone: 314-378-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005286
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: