Healthcare Provider Details

I. General information

NPI: 1114755063
Provider Name (Legal Business Name): SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 DELMAR BLVD
SAINT LOUIS MO
63108-1027
US

IV. Provider business mailing address

5219 DELMAR BLVD
SAINT LOUIS MO
63108-1027
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-1437
  • Fax: 314-361-9355
Mailing address:
  • Phone: 314-454-1437
  • Fax: 314-361-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SELAM DEUTSCHMANN
Title or Position: OWNER
Credential: D.C.
Phone: 314-454-1437