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General NPI Number Information
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NPI Number | 1114301678
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Entity Type | Organization
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Legal Business Name | MD HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 11903 SAINT CHARLES ROCK RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2623
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Country | US
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Telephone | 314-739-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 11903 SAINT CHARLES ROCK RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2623
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Country | US
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Telephone | 314-739-2900
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ANGELA PERRY
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Credential |
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Telephone | 314-739-2900
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | R9C95
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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