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General NPI Number Information
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NPI Number | 1003026170
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S CHIROPRACTIC HEALTH CENTER LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1304 BRENDA AVE SUITE B
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City | PERRYVILLE
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State | MO
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Zip | 63775-2303
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Country | US
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Telephone | 573-547-3113
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Fax | 573-547-1166
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Provider Business Mailing Address
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Address Line | 1304 BRENDA AVE SUITE B
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City | PERRYVILLE
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State | MO
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Zip | 63775-2303
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Country | US
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Telephone | 573-547-3113
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Fax | 573-547-1166
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC WALTEMATE
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Credential | D.C.
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Telephone | 573-547-3113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2002013828
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License Number State | MO
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