Healthcare Provider Details

I. General information

NPI: 1588812663
Provider Name (Legal Business Name): JEFFREY SCOTT O'GUIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/12/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10733 BIG BEND RD STE 100
KIRKWOOD MO
63122-6071
US

IV. Provider business mailing address

10733 BIG BEND RD STE 100
KIRKWOOD MO
63122-6071
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-5300
  • Fax:
Mailing address:
  • Phone: 314-402-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008027066
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: