Healthcare Provider Details

I. General information

NPI: 1518187616
Provider Name (Legal Business Name): THE CHIROPRACTIC WELLNESS CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OFALLON COMMONS DR
O FALLON MO
63368-7931
US

IV. Provider business mailing address

111 OFALLON COMMONS DR
O FALLON MO
63368-7931
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-0970
  • Fax:
Mailing address:
  • Phone: 636-978-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2006019910
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2006024312
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2006024311
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. WHITNEY E HAMED
Title or Position: OWNER
Credential: D.O.
Phone: 636-978-0970