Healthcare Provider Details

I. General information

NPI: 1912103672
Provider Name (Legal Business Name): JAMES ROBERT NEUWIRTH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 230
SAINT LOUIS MO
63122-7356
US

IV. Provider business mailing address

416 REDWOOD FOREST DR
BALLWIN MO
63021-5756
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax: 314-821-9889
Mailing address:
  • Phone: 314-822-1502
  • Fax: 314-821-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number006776
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: