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General NPI Number Information
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NPI Number | 1518363803
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Entity Type | Organization
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Legal Business Name | THAKE CHIROPRACTIC AND WELLNESS, LLC
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 25 PARK PL
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City | SAINT PETERS
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State | MO
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Zip | 63376-3146
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Country | US
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Telephone | 330-265-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 25 PARK PL
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City | SAINT PETERS
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State | MO
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Zip | 63376-3146
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Country | US
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Telephone | 330-265-6113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIANNE CHRISTINE THAKE
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Credential | D.C.
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Telephone | 330-265-6113
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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 | 2014038935
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License Number State | MO
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