Healthcare Provider Details

I. General information

NPI: 1154927861
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC AND REHAB OF EUREKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 THE LEGENDS PKWY STE 158
EUREKA MO
63025-3803
US

IV. Provider business mailing address

223 SALT LICK RD # 280
SAINT PETERS MO
63376-5974
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-1010
  • Fax:
Mailing address:
  • Phone: 636-938-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDEN RACE
Title or Position: COO
Credential: DC
Phone: 636-938-1010