Healthcare Provider Details

I. General information

NPI: 1821363037
Provider Name (Legal Business Name): CHIROPRACTIC CENTRE OF CRESTWOOD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 WATSON RD
SAINT LOUIS MO
63126-2235
US

IV. Provider business mailing address

9109 WATSON RD
SAINT LOUIS MO
63126-2235
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-4101
  • Fax: 314-961-1886
Mailing address:
  • Phone: 314-961-4101
  • Fax: 314-961-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number004518
License Number StateMO

VIII. Authorized Official

Name: DR. ANTHONY W CALANDRO
Title or Position: PRESIDENT
Credential: DC
Phone: 314-961-4101