Healthcare Provider Details

I. General information

NPI: 1407890148
Provider Name (Legal Business Name): WILLIAM VAN NESSING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 RAYMOND DR
SAINT CHARLES MO
63301-4872
US

IV. Provider business mailing address

629 ST FRANCOIS
FLORISSANT MO
63031-4919
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-2244
  • Fax: 636-946-6975
Mailing address:
  • Phone: 314-839-4646
  • Fax: 314-839-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number004435
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number004435
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: