Healthcare Provider Details

I. General information

NPI: 1003292939
Provider Name (Legal Business Name): BUELTMANN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 GRAVOIS RD
SAINT LOUIS MO
63127-1803
US

IV. Provider business mailing address

7040 DARTMOUTH AVE FL 2
SAINT LOUIS MO
63130-2314
US

V. Phone/Fax

Practice location:
  • Phone: 314-346-6822
  • Fax:
Mailing address:
  • Phone: 314-346-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015001855
License Number StateMO

VIII. Authorized Official

Name: DR. KATIE BUELTMANN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 314-346-6822