Healthcare Provider Details

I. General information

NPI: 1609647981
Provider Name (Legal Business Name): X CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MAIN PLAZA DR
WENTZVILLE MO
63385-1170
US

IV. Provider business mailing address

33 SPANGLE WAY DR
O FALLON MO
63366-5525
US

V. Phone/Fax

Practice location:
  • Phone: 636-639-8944
  • Fax:
Mailing address:
  • Phone: 714-624-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CANDICE JUSTINE EXELY
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 714-624-9538