Healthcare Provider Details

I. General information

NPI: 1548421282
Provider Name (Legal Business Name): CHIROPRACTIC CENTRE-OLIVE/270,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11935 OLIVE BLVD
SAINT LOUIS MO
63141-6729
US

IV. Provider business mailing address

11935 OLIVE BLVD
SAINT LOUIS MO
63141-6729
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-5899
  • Fax:
Mailing address:
  • Phone: 314-432-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCE005091
License Number StateMO

VIII. Authorized Official

Name: DR. RHONDA L JONES
Title or Position: CHIROPRACTOR AND OWNER
Credential: DC
Phone: 314-432-0005