Healthcare Provider Details

I. General information

NPI: 1548484819
Provider Name (Legal Business Name): FEET FOR LIFE CENTERS INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8637 DELMAR BLVD
SAINT LOUIS MO
63124-1906
US

IV. Provider business mailing address

8637 DELMAR BLVD
SAINT LOUIS MO
63124-1906
US

V. Phone/Fax

Practice location:
  • Phone: 314-983-0303
  • Fax: 314-983-2777
Mailing address:
  • Phone: 314-983-0303
  • Fax: 314-983-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2010024583
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2012010878
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000603
License Number StateMO

VIII. Authorized Official

Name: MRS. AMEY DRAKE
Title or Position: ADMIN MANAGER
Credential:
Phone: 314-983-0303