Healthcare Provider Details

I. General information

NPI: 1972728467
Provider Name (Legal Business Name): ACTIVE CARE CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N BALLAS RD SUITE C 55
SAINT LOUIS MO
63131-2321
US

IV. Provider business mailing address

2821 N BALLAS RD SUITE C 55
SAINT LOUIS MO
63131-2321
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-1805
  • Fax: 314-989-1836
Mailing address:
  • Phone: 314-989-1805
  • Fax: 314-989-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PILAR MINETT WILLIAMSEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 314-989-1805