=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487067187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEIM CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2014
-----------------------------------------------------
Last Update Date | 06/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 N CLOVERLEAF DR SUITE M
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-6436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-248-9745
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 SERAPIS CT
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63303-1764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-248-9745
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ERIC SEIM
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 636-248-9745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2014013830
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------