Healthcare Provider Details

I. General information

NPI: 1245524453
Provider Name (Legal Business Name): JASON G. BIONDO, D.C., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 240
KIRKWOOD MO
63122-7356
US

IV. Provider business mailing address

1099 MILWAUKEE ST SUITE 240
KIRKWOOD MO
63122-7356
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax: 314-821-9889
Mailing address:
  • Phone: 314-822-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2011012761
License Number StateMO

VIII. Authorized Official

Name: DR. JASON GREGORY BIONDO
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 314-822-1502