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General NPI Number Information
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NPI Number | 1679766810
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Entity Type | Organization
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Legal Business Name | RAINTREE CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 4 HICKORY RIDGE RD SUITE #800
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City | HILLSBORO
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State | MO
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Zip | 63050-5100
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Country | US
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Telephone | 636-797-5100
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Fax | 636-797-2745
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Provider Business Mailing Address
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Address Line | 4 HICKORY RIDGE RD SUITE #800
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City | HILLSBORO
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State | MO
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Zip | 63050-5100
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Country | US
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Telephone | 636-797-5100
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Fax | 636-797-2745
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACEY A. MAXWELL-KROCKENBERGER
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Credential | D.C.,M.T.A.A.,L.M.T.
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Telephone | 636-797-5100
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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 | 2005005613
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License Number State | MO
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