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General NPI Number Information
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NPI Number | 1548417850
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Entity Type | Organization
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Legal Business Name | SANDRA G LEVY DC LLC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 608 N MCKNIGHT RD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-4911
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Country | US
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Telephone | 314-991-5655
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Fax | 314-991-4872
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Provider Business Mailing Address
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Address Line | 608 N MCKNIGHT RD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-4911
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Country | US
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Telephone | 314-991-5655
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Fax | 314-991-4872
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA G LEVY
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Credential | DC
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Telephone | 314-991-5655
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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 | 006343
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License Number State | MO
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