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General NPI Number Information
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NPI Number | 1841426152
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Entity Type | Organization
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Legal Business Name | GATEWAY FAMILY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 6060 TELEGRAPH RD SUITE A
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4762
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Country | US
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Telephone | 314-846-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 TELEGRAPH RD SUITE A
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4762
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Country | US
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Telephone | 314-846-6700
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | ANDY HUFFMAN
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Credential | D.C.
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Telephone | 314-846-6700
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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 | 2009000493
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License Number State | MO
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