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General NPI Number Information
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NPI Number | 1205000106
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Entity Type | Organization
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Legal Business Name | AFFTON LEMAY CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 4006 BAYLESS AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63125-1314
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Country | US
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Telephone | 314-631-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 4006 BAYLESS AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63125-1314
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Country | US
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Telephone | 314-631-5550
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD ALLEN HENGEL
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Credential | DC
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Telephone | 314-631-5550
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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 | 005518
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License Number State | MO
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