Healthcare Provider Details

I. General information

NPI: 1942129564
Provider Name (Legal Business Name): DYNAMIC REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10435 CLAYTON RD STE 120
SAINT LOUIS MO
63131-2930
US

IV. Provider business mailing address

10435 CLAYTON RD STE 120
SAINT LOUIS MO
63131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 810-434-6210
  • Fax:
Mailing address:
  • Phone: 810-434-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. PARKER GRUNDMAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 810-434-6210