Healthcare Provider Details

I. General information

NPI: 1912379769
Provider Name (Legal Business Name): KINETIC CARE CHIROPRACTIC & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 SALT LICK RD
SAINT PETERS MO
63376-1288
US

IV. Provider business mailing address

511 SALT LICK RD
SAINT PETERS MO
63376-1288
US

V. Phone/Fax

Practice location:
  • Phone: 618-401-1767
  • Fax:
Mailing address:
  • Phone: 618-401-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015015035
License Number StateMO

VIII. Authorized Official

Name: DR. ERIC BYERLY
Title or Position: CHIROPRACTIC PHYSICIAN/OWNER
Credential: D.C.
Phone: 618-401-1767