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General NPI Number Information
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NPI Number | 1043523301
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY CHIROPRACTIC & REHABILITATION, INC.
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 5207 WARREN RD
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City | IMPERIAL
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State | MO
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Zip | 63052-1521
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Country | US
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Telephone | 636-464-5900
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Fax | 636-464-5901
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Provider Business Mailing Address
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Address Line | 5207 WARREN RD
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City | IMPERIAL
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State | MO
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Zip | 63052-1521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PAUL AMATO
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Credential |
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Telephone | 636-464-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2010000782
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License Number State | MO
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