Healthcare Provider Details

I. General information

NPI: 1477826030
Provider Name (Legal Business Name): COMPLETE WELLNESS CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 03/20/2012
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

2241 BLUESTONE DR
SAINT CHARLES MO
63303-6705
US

V. Phone/Fax

Practice location:
  • Phone: 636-751-3150
  • Fax: 636-940-9990
Mailing address:
  • Phone: 636-751-3150
  • Fax: 636-940-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2012001576
License Number StateMO

VIII. Authorized Official

Name: DR. VICTORIA MARIE PATTERSON
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 636-751-3150