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General NPI Number Information
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NPI Number | 1548686025
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Entity Type | Organization
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Legal Business Name | CORE CONCEPTS CHIROPRACTIC
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Dates
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Enumeration Date | 03/08/2014
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 107 OLYMPIC WAY
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City | SAINT PETERS
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State | MO
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Zip | 63376-1664
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Country | US
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Telephone | 636-244-5223
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Fax | 636-244-5224
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Provider Business Mailing Address
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Address Line | 107 OLYMPIC WAY
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City | SAINT PETERS
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State | MO
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Zip | 63376-1664
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Country | US
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Telephone | 636-244-5223
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Fax | 636-244-5224
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. ABIGAIL T.L. NEWSOM
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Credential | D.C.
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Telephone | 636-244-5223
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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 | 2014002112
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License Number State | MO
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