Healthcare Provider Details

I. General information

NPI: 1407851280
Provider Name (Legal Business Name): DR. ROBERT S GELLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 CAMPUS DR
SAINT CHARLES MO
63301-1048
US

IV. Provider business mailing address

2050 CAMPUS DR
SAINT CHARLES MO
63301-1048
US

V. Phone/Fax

Practice location:
  • Phone: 636-724-4010
  • Fax:
Mailing address:
  • Phone: 636-724-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: