Healthcare Provider Details

I. General information

NPI: 1093150930
Provider Name (Legal Business Name): HOFFMAN FAMILY CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 MID RIVERS MALL DR
SAINT PETERS MO
63376-1593
US

IV. Provider business mailing address

355 MID RIVERS MALL DR
SAINT PETERS MO
63376-1593
US

V. Phone/Fax

Practice location:
  • Phone: 636-970-0155
  • Fax:
Mailing address:
  • Phone: 636-970-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2013001703
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2013001703
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2013001703
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2013001703
License Number StateMO

VIII. Authorized Official

Name: DR. JUSTIN HOFFMAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 636-970-0155