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General NPI Number Information
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NPI Number | 1518384163
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Entity Type | Organization
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Legal Business Name | EDMISTONE ACUPUNCTURE & CHIROPRACTIC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1207 THOUVENOT LN STE 300
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City | O FALLON
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State | IL
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Zip | 62269-8916
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Country | US
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Telephone | 618-624-8080
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Fax | 618-206-8070
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Provider Business Mailing Address
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Address Line | 1207 THOUVENOT LN STE 300
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City | O FALLON
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State | IL
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Zip | 62269-8916
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Country | US
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Telephone | 618-624-8080
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Fax | 618-206-8070
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD ALLEN EDMISTON
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Credential | D.C.
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Telephone | 618-624-8080
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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 | 03801464
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License Number State | IL
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