Healthcare Provider Details

I. General information

NPI: 1790128007
Provider Name (Legal Business Name): KIERNAN CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 11TH ST
SAINT LOUIS MO
63104-4345
US

IV. Provider business mailing address

2401 S 11TH ST
SAINT LOUIS MO
63104-4345
US

V. Phone/Fax

Practice location:
  • Phone: 314-865-2450
  • Fax: 314-865-2450
Mailing address:
  • Phone: 314-865-2450
  • Fax: 314-865-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN EDWARD KIERNAN JR.
Title or Position: PRESIDENT
Credential: D.C.
Phone: 314-865-2450