Healthcare Provider Details

I. General information

NPI: 1780915637
Provider Name (Legal Business Name): ST. ROBERT CHIROPRACTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 OLD ROUTE 66 SUITE 2D
SAINT ROBERT MO
65584-4601
US

IV. Provider business mailing address

PO BOX 797
SAINT ROBERT MO
65584-0797
US

V. Phone/Fax

Practice location:
  • Phone: 573-336-2230
  • Fax: 573-336-4285
Mailing address:
  • Phone: 573-336-2230
  • Fax: 573-336-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCE06439
License Number StateMO

VIII. Authorized Official

Name: MS. SONJA A KAMPLAIN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 573-336-2230