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General NPI Number Information
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NPI Number | 1649542341
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Entity Type | Organization
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Legal Business Name | ADIO FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 2330 HWY 94 S OUTER RD
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City | SAINT CHARLES
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State | MO
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Zip | 63303-8301
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Country | US
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Telephone | 636-498-2346
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Fax | 636-498-2727
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Provider Business Mailing Address
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Address Line | 2330 HWY 94 S OUTER RD
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City | SAINT CHARLES
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State | MO
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Zip | 63303-8301
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Country | US
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Telephone | 636-498-2346
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Fax | 636-498-2727
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID WALLACE
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Credential | D.C.
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Telephone | 636-498-2346
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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 | 006811
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License Number State | MO
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