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General NPI Number Information
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NPI Number | 1821429077
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Entity Type | Organization
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Legal Business Name | PROFICIENT CHIROPRACTIC HOLDINGS LLC
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 2050 WOODSON RD SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63114-5644
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Country | US
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Telephone | 314-276-4154
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Fax | 314-447-0726
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Provider Business Mailing Address
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Address Line | 10251 LINCOLN TRL SUITE 4
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-1846
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Country | US
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Telephone | 314-276-4154
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Fax | 314-447-0726
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDGAR EVERETT III
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Credential | DC
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Telephone | 314-276-4154
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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 |
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License Number State | MO
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