Healthcare Provider Details

I. General information

NPI: 1659622157
Provider Name (Legal Business Name): AUTUMN REBECCA BARTON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S LINDBERGH BLVD STE 3
SAINT LOUIS MO
63127-1831
US

IV. Provider business mailing address

4600 S LINDBERGH BLVD STE 3
SAINT LOUIS MO
63127-1831
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0027
  • Fax:
Mailing address:
  • Phone: 314-729-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2012033594
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: