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General NPI Number Information
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NPI Number | 1568661080
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Entity Type | Organization
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Legal Business Name | WINCHESTER CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 40 WALTER CT
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City | MOSCOW MILLS
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State | MO
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Zip | 63362-1197
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Country | US
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Telephone | 636-356-5557
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Fax | 636-356-5558
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Provider Business Mailing Address
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Address Line | 40 WALTER CT
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City | MOSCOW MILLS
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State | MO
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Zip | 63362-1197
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Country | US
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Telephone | 636-356-5557
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Fax | 636-356-5558
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. MATTHEW HILGEFORT
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Credential | D.C.
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Telephone | 636-356-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2004010186
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2003011597
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License Number State | MO
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