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General NPI Number Information
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NPI Number | 1760038392
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Entity Type | Organization
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Legal Business Name | MELISSA GEORGEVITCH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 724 W OSAGE ST
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City | PACIFIC
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State | MO
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Zip | 63069-1219
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Country | US
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Telephone | 636-422-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 W HAWTHORNE ST
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City | PACIFIC
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State | MO
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Zip | 63069-1849
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Country | US
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Telephone | 314-681-3221
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. MELISSA MARIE GEORGEVITCH
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Credential | DC
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Telephone | 314-681-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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