Healthcare Provider Details

I. General information

NPI: 1578681565
Provider Name (Legal Business Name): ESSEN CHIROPRACTIC AND ACUPUNCTURE, L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11770 MANCHESTER ROAD
DES PERES MO
63131-9998
US

IV. Provider business mailing address

11770 MANCHESTER ROAD
DES PERES MO
63131-9998
US

V. Phone/Fax

Practice location:
  • Phone: 636-825-0360
  • Fax: 636-825-0360
Mailing address:
  • Phone: 636-825-0360
  • Fax: 636-825-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2001011183
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2001011183
License Number StateMO

VIII. Authorized Official

Name: DR. JOAN E ESSEN
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 636-825-0360