Healthcare Provider Details

I. General information

NPI: 1073427761
Provider Name (Legal Business Name): DECKER SPORTS AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 BAILEY RD
CRYSTAL CITY MO
63019-1702
US

IV. Provider business mailing address

502 BAILEY RD
CRYSTAL CITY MO
63019-1702
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-2405
  • Fax:
Mailing address:
  • Phone: 314-270-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREGORY DECKER
Title or Position: PHYSICIAN/PARTNER
Credential: MD
Phone: 314-270-2405