Healthcare Provider Details

I. General information

NPI: 1821429077
Provider Name (Legal Business Name): PROFICIENT CHIROPRACTIC HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 WOODSON RD SUITE 101
SAINT LOUIS MO
63114-5644
US

IV. Provider business mailing address

10251 LINCOLN TRL SUITE 4
FAIRVIEW HEIGHTS IL
62208-1846
US

V. Phone/Fax

Practice location:
  • Phone: 314-276-4154
  • Fax: 314-447-0726
Mailing address:
  • Phone: 314-276-4154
  • Fax: 314-447-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDGAR EVERETT III
Title or Position: OWNER
Credential: DC
Phone: 314-276-4154