Healthcare Provider Details

I. General information

NPI: 1750120838
Provider Name (Legal Business Name): MATTHEW HUETTER DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
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: 314-718-7971
  • Fax: 314-991-0205
Mailing address:
  • Phone: 314-718-7971
  • Fax: 314-991-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW THOMAS HUETTER
Title or Position: OWNER
Credential: DC
Phone: 501-412-6302