Healthcare Provider Details

I. General information

NPI: 1962045724
Provider Name (Legal Business Name): ADRIAN GUTIERREZ DC, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 JUNGERMANN RD
SAINT PETERS MO
63376-6963
US

IV. Provider business mailing address

1232 JUNGERMANN RD
SAINT PETERS MO
63376-6963
US

V. Phone/Fax

Practice location:
  • Phone: 623-440-8491
  • Fax:
Mailing address:
  • Phone: 623-440-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2021009678
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013544
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number08003124A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number08003124A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003124A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: