Healthcare Provider Details

I. General information

NPI: 1861843500
Provider Name (Legal Business Name): PARADIGM HOLISTIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CALWOOD DR
SAINT PETERS MO
63376-3561
US

IV. Provider business mailing address

223 SALT LICK RD STE 213
SAINT PETERS MO
63376-5974
US

V. Phone/Fax

Practice location:
  • Phone: 314-406-4894
  • Fax: 636-387-1397
Mailing address:
  • Phone: 314-406-4894
  • Fax: 636-387-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005954
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005954
License Number StateMO

VIII. Authorized Official

Name: DR. JULIANNE MARTINY
Title or Position: MANAGER
Credential: D.C.
Phone: 314-406-4894