Healthcare Provider Details

I. General information

NPI: 1821070582
Provider Name (Legal Business Name): MICHAEL VIANIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 230
KIRKWOOD MO
63122-7355
US

IV. Provider business mailing address

1099 MILWAUKEE ST SUITE 230
KIRKWOOD MO
63122-7355
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-9449
  • Fax:
Mailing address:
  • Phone: 314-821-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2005000488
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: