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General NPI Number Information
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NPI Number | 1083039929
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Entity Type | Individual
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Provider Name | JULIANNE CHRISTINE THAKE D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 2705 SAINT PETERS HOWELL RD STE J
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City | SAINT PETERS
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State | MO
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Zip | 63376-2821
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Country | US
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Telephone | 636-248-9561
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Fax |
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Provider Business Mailing Address
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Address Line | 25 PARK PL
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City | SAINT PETERS
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State | MO
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Zip | 63376-3146
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Country | US
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Telephone | 330-265-6113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2014038935
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License Number State | MO
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