Healthcare Provider Details

I. General information

NPI: 1336470707
Provider Name (Legal Business Name): EMBER F BEUTEL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2010
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239B LEMAY FERRY RD
SAINT LOUIS MO
63125-4419
US

IV. Provider business mailing address

4600 S LINDBERGH BLVD STE 2
SAINT LOUIS MO
63127-1831
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-6500
  • Fax: 314-200-6502
Mailing address:
  • Phone: 573-724-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2010000897
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: