=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518553890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFIC CHIROPRACTIC CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2020
-----------------------------------------------------
Last Update Date | 12/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 W OSAGE ST
-----------------------------------------------------
City | PACIFIC
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63069-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-257-4622
-----------------------------------------------------
Fax | 636-257-4622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1456 MERAMEC AVE
-----------------------------------------------------
City | PACIFIC
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63069-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-267-2114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRISTINA M HUFF
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 636-257-4622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------