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General NPI Number Information
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NPI Number | 1992836506
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Entity Type | Organization
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Legal Business Name | WINGHAVEN CHIROPRACTIC PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 9979 WINGHAVEN BLVD SUITE 204
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City | O FALLON
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State | MO
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Zip | 63368-3627
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Country | US
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Telephone | 636-695-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 9979 WINGHAVEN BLVD SUITE 204
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City | O FALLON
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State | MO
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Zip | 63368-3627
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Country | US
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Telephone | 636-695-2100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TODD JOSEPH STOJEBA
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Credential | D.C.
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Telephone | 636-695-2100
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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 | 005845
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License Number State | MO
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