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General NPI Number Information
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NPI Number | 1023769312
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Entity Type | Organization
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Legal Business Name | AGE WELL HEALTH SOLUTIONS L.L.C.
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 134 ENCHANTED PKWY STE 104
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City | MANCHESTER
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State | MO
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Zip | 63021-5495
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Country | US
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Telephone | 314-227-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 910 16TH ST
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City | MARYSVILLE
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State | MI
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Zip | 48040-1627
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Country | US
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Telephone | 314-330-5707
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KEVIN N. RUDBERG
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Credential | DC
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Telephone | 314-330-5707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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