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General NPI Number Information
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NPI Number | 1194169334
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Entity Type | Organization
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Legal Business Name | CRESTWOOD BACK AND NECK PAIN CLINIC
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 9109 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63126-2235
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Country | US
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Telephone | 314-961-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 9109 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63126-2235
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Country | US
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Telephone | 314-961-4101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICK CALANDRO
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Credential |
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Telephone | 314-961-4101
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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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