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General NPI Number Information
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NPI Number | 1053515957
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 510 BAXTER RD SUITE #8
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7032
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Country | US
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Telephone | 636-207-6600
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Fax | 636-207-6631
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Provider Business Mailing Address
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Address Line | 510 BAXTER RD SUITE #8
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7032
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Country | US
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Telephone | 636-207-6600
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Fax | 636-207-6631
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. JENNIFER CHRISTINE KANE
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Credential | D.C.
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Telephone | 314-496-8044
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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 | 2001011188
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License Number State | MO
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