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General NPI Number Information
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NPI Number | 1154093151
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Entity Type | Organization
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Legal Business Name | LAKE SAINT LOUIS CHIROPRACTIC AND REHAB LLC
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 910 BENT OAK CT
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1473
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Country | US
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Telephone | 636-265-1116
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Fax | 866-519-5622
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Provider Business Mailing Address
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Address Line | 910 BENT OAK CT
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1473
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Country | US
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Telephone | 636-265-1116
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Fax | 866-519-5622
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Authorized Official
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Title or Position | OWNER
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Name | JAMES BAXTER
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Credential |
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Telephone | 636-265-1116
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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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