Healthcare Provider Details

I. General information

NPI: 1053412155
Provider Name (Legal Business Name): BARTON J COLEMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/25/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N COMMERCIAL AVE
SAINT CLAIR MO
63077-1103
US

IV. Provider business mailing address

PO BOX 352
SAINT ALBANS MO
63073-0352
US

V. Phone/Fax

Practice location:
  • Phone: 636-629-2414
  • Fax:
Mailing address:
  • Phone: 314-239-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006684
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: