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General NPI Number Information
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NPI Number | 1720319239
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Entity Type | Organization
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Legal Business Name | ACCIDENT INJURY HEALTHCARE
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 440 N 4TH ST # 295
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City | SAINT LOUIS
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State | MO
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Zip | 63102-2654
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Country | US
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Telephone | 314-703-4439
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Fax |
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Provider Business Mailing Address
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Address Line | 440 N 4TH ST # 295
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City | SAINT LOUIS
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State | MO
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Zip | 63102-2654
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Country | US
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Telephone | 314-703-4439
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MANAGING MEMBER
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Name | DR. DAVID WILLS
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Credential |
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Telephone | 314-703-4439
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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 | 006568
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD101729
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License Number State | MO
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