Healthcare Provider Details

I. General information

NPI: 1568661080
Provider Name (Legal Business Name): WINCHESTER CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WALTER CT
MOSCOW MILLS MO
63362-1197
US

IV. Provider business mailing address

40 WALTER CT
MOSCOW MILLS MO
63362-1197
US

V. Phone/Fax

Practice location:
  • Phone: 636-356-5557
  • Fax: 636-356-5558
Mailing address:
  • Phone: 636-356-5557
  • Fax: 636-356-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2004010186
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2003011597
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW HILGEFORT
Title or Position: OWNER/MANAGER
Credential: D.C.
Phone: 636-356-5557