Healthcare Provider Details

I. General information

NPI: 1609095405
Provider Name (Legal Business Name): ST LOUIS INJURY AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 BIG BEND BLVD SUITE 107
SAINT LOUIS MO
63119-2714
US

IV. Provider business mailing address

8045 BIG BEND BLVD SUITE 107
SAINT LOUIS MO
63119-2714
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-7181
  • Fax: 314-961-6323
Mailing address:
  • Phone: 314-961-7181
  • Fax: 314-961-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILLIAM D CRAGG
Title or Position: OWNER
Credential: DC
Phone: 314-961-7181