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General NPI Number Information
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NPI Number | 1407569197
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Entity Type | Organization
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Legal Business Name | DETTENMEIER CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 5650 MEXICO RD STE 20
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City | SAINT PETERS
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State | MO
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Zip | 63376-1696
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Country | US
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Telephone | 636-936-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 232 BOONE HILLS DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-5362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM DETTENMEIER
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Credential | DC
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Telephone | 636-542-8905
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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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