=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255113403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COURY SPINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2023
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 S WOODS MILL RD STE 35W
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-548-6860
-----------------------------------------------------
Fax | 314-548-6866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 S WOODS MILL RD STE 35W
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-548-6860
-----------------------------------------------------
Fax | 314-548-6866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN COURY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 314-548-6860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------