Healthcare Provider Details

I. General information

NPI: 1366782088
Provider Name (Legal Business Name): SUNSET HILLS FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SOUTH LINDBERGH AVE SUITE 3
ST. LOUIS MO
63127
US

IV. Provider business mailing address

4600 SOUTH LINDBERGH AVE SUITE 3
ST. LOUIS MO
63127
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0027
  • Fax: 314-729-1015
Mailing address:
  • Phone: 314-729-0027
  • Fax: 314-729-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012041149
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number212041149
License Number StateMO

VIII. Authorized Official

Name: DR. BRITTANY JEAN WARREN
Title or Position: OWNER
Credential: D.C.
Phone: 314-729-0027