Healthcare Provider Details

I. General information

NPI: 1124697669
Provider Name (Legal Business Name): ANDREW CHASE HORROCKS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 175
SAINT LOUIS MO
63141-8664
US

IV. Provider business mailing address

12855 N 40 DR STE 175
SAINT LOUIS MO
63141-8664
US

V. Phone/Fax

Practice location:
  • Phone: 414-434-9600
  • Fax: 314-434-9601
Mailing address:
  • Phone: 314-434-9600
  • Fax: 314-434-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2025027596
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: