Healthcare Provider Details

I. General information

NPI: 1982988986
Provider Name (Legal Business Name): MIDTOWN BACK AND NECK CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2011
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 LOCUST ST STE 200
SAINT LOUIS MO
63103-1230
US

IV. Provider business mailing address

3141 LOCUST ST STE 200
SAINT LOUIS MO
63103-1230
US

V. Phone/Fax

Practice location:
  • Phone: 149-321-2773
  • Fax: 314-932-1278
Mailing address:
  • Phone: 314-932-1277
  • Fax: 314-932-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2011021467
License Number StateMO

VIII. Authorized Official

Name: DR. TERENCE MICHAEL CROWLEY
Title or Position: OWNER
Credential: DC
Phone: 314-932-1277