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General NPI Number Information
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NPI Number | 1295527877
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Entity Type | Organization
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Legal Business Name | MOMPER SPINE & SPORT LLC
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 905 MAIN PLAZA DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-1168
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Country | US
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Telephone | 636-856-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 BONHOMME LAKE DR APT L
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City | SAINT LOUIS
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State | MO
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Zip | 63132-5307
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Country | US
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Telephone | 260-433-0687
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MARY MOMPER
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Credential | DC
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Telephone | 260-433-0687
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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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