Healthcare Provider Details

I. General information

NPI: 1861706426
Provider Name (Legal Business Name): OLEARY CHIROPRACTIC HEALING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 FLORAL DR
O FALLON MO
63368-6876
US

IV. Provider business mailing address

173 LONG RD STE 100
CHESTERFIELD MO
63005-1255
US

V. Phone/Fax

Practice location:
  • Phone: 314-607-3142
  • Fax:
Mailing address:
  • Phone: 636-530-1212
  • Fax: 636-536-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2010016307
License Number StateMO

VIII. Authorized Official

Name: DR. DANIEL KENNETH O'LEARY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 314-607-3142