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General NPI Number Information
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NPI Number | 1114120649
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Entity Type | Organization
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Legal Business Name | FRONTIER INTEGRATED HEALTH CENTER INC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 199 FRONTIER PARK DR
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City | O FALLON
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State | MO
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Zip | 63366-3963
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Country | US
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Telephone | 636-379-5934
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Fax | 636-410-3323
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Provider Business Mailing Address
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Address Line | 199 FRONTIER PARK DR
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City | O FALLON
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State | MO
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Zip | 63366-3963
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Country | US
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Telephone | 636-379-5934
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Fax | 636-410-3323
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND JAMES OTTOMEYER III
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Credential | DC
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Telephone | 636-379-5934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 112431
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License Number State | MO
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