Healthcare Provider Details

I. General information

NPI: 1790249233
Provider Name (Legal Business Name): CREATE HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-991-2295
  • Fax:
Mailing address:
  • Phone: 314-991-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CURTIS ANDERSON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 757-508-4316