Healthcare Provider Details

I. General information

NPI: 1275000747
Provider Name (Legal Business Name): CANDICE JUSTINE EXELY DC, CCSP, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: C.J. EXELY

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
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 TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2017002741
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023050816
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: