Healthcare Provider Details

I. General information

NPI: 1023788577
Provider Name (Legal Business Name): PREMIER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WOLFRUM RD STE 101
WELDON SPRING MO
63304-7958
US

IV. Provider business mailing address

1120 WOLFRUM RD STE 101
WELDON SPRING MO
63304-7958
US

V. Phone/Fax

Practice location:
  • Phone: 412-596-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA STEPHENSON
Title or Position: OWNER
Credential: DC
Phone: 636-244-1748