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General NPI Number Information
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NPI Number | 1710416755
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Entity Type | Organization
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Legal Business Name | ST LOUIS JOINT AND BACK PAIN SPECIALISTS LLC
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Dates
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Enumeration Date | 06/04/2017
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Last Update Date | 06/04/2017
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Provider Practice Location Address
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Address Line | 10420 OLD OLIVE STREET RD STE 205
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City | CREVE COEUR
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State | MO
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Zip | 63141-5937
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Country | US
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Telephone | 314-516-3289
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 NYKIEL CT
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City | BALLWIN
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State | MO
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Zip | 63011-4246
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADAM SHOMSTEIN
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Credential | DO
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Telephone | 314-516-3289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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