Healthcare Provider Details

I. General information

NPI: 1154012516
Provider Name (Legal Business Name): SAHIN DZANANOVIC DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15876 FOUNTAIN PLAZA DR
ELLISVILLE MO
63011
US

IV. Provider business mailing address

6318 SPRIG OAK CT
SAINT LOUIS MO
63128-4315
US

V. Phone/Fax

Practice location:
  • Phone: 636-251-5556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023016574
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: