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General NPI Number Information
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NPI Number | 1972751956
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Entity Type | Organization
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Legal Business Name | INMOTION CHIROPRACTIC AND WELLNESS LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 3460 HAMPTON AVE STE104
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1945
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Country | US
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Telephone | 618-795-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 3460 HAMPTON AVE STE104
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1945
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Country | US
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Telephone | 618-795-6910
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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 | DR. RYAN THOMAS DIEFENBACH
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Credential | D.C.
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Telephone | 618-795-6910
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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 | 2008026720
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License Number State | MO
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