Healthcare Provider Details

I. General information

NPI: 1518270792
Provider Name (Legal Business Name): JEFFREY S. O'GUIN D.C., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 S KIRKWOOD RD SUITE 100
SAINT LOUIS MO
63122-6169
US

IV. Provider business mailing address

439 S KIRKWOOD RD SUITE 100
SAINT LOUIS MO
63122-6169
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-5300
  • Fax: 314-822-5324
Mailing address:
  • Phone: 314-822-5300
  • Fax: 314-822-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number2008027066
License Number StateMO

VIII. Authorized Official

Name: DR. JEFFREY SCOTT O'GUIN
Title or Position: CHIROPRACTIC
Credential: D.C.
Phone: 314-822-5300