Healthcare Provider Details

I. General information

NPI: 1386053122
Provider Name (Legal Business Name): DUEY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 BLUESTONE DR
SAINT CHARLES MO
63303-6705
US

IV. Provider business mailing address

507 ELM CROSSING CT
BALLWIN MO
63021-7479
US

V. Phone/Fax

Practice location:
  • Phone: 636-236-9614
  • Fax: 636-940-9990
Mailing address:
  • Phone: 636-236-9614
  • Fax: 636-940-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2013013356
License Number StateMO

VIII. Authorized Official

Name: DR. WESLEY DUEY
Title or Position: OFFICE MANAGER/ACTING PHYSICIAN
Credential: D.C.
Phone: 636-236-9614