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General NPI Number Information
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NPI Number | 1447550389
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Entity Type | Individual
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Provider Name | SHERILYN MATTAROCCI HAUG D.C., PTA
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Gender | Female
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 363 JUNGERMANN RD #261
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City | SAINT PETERS
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State | MO
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Zip | 63376-5371
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Country | US
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Telephone | 636-244-3921
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Fax | 636-244-3922
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Provider Business Mailing Address
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Address Line | 363 JUNGERMANN RD #261
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City | SAINT PETERS
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State | MO
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Zip | 63376-5371
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Country | US
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Telephone | 636-244-3921
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Fax | 636-244-3922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2009028139
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 23837
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2012003317
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License Number State | MO
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