Healthcare Provider Details

I. General information

NPI: 1396090502
Provider Name (Legal Business Name): ABBY ROSE PAINTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 FRONT ST SUITE 101
LABADIE MO
63055-1223
US

IV. Provider business mailing address

1054 ARROWHEAD LN
UNION MO
63084-4555
US

V. Phone/Fax

Practice location:
  • Phone: 636-742-3733
  • Fax:
Mailing address:
  • Phone: 636-390-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012023337
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: