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General NPI Number Information
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NPI Number | 1629492483
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Entity Type | Organization
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Legal Business Name | NATURAL BRIDGE INJURY CENTER, LLC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 8947 NATURAL BRIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63121-3916
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Country | US
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Telephone | 314-738-9104
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Fax | 314-728-9105
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Provider Business Mailing Address
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Address Line | 8947 NATURAL BRIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63121-3916
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Country | US
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Telephone | 314-738-9104
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Fax | 314-738-9105
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Authorized Official
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Title or Position | OWNER
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Name | MARIO RODRIGUEZ
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Credential |
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Telephone | 314-738-9104
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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 |
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License Number State |
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