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General NPI Number Information
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NPI Number | 1992986681
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Entity Type | Organization
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Legal Business Name | MULLIGAN CHIROPRACTIC ORTHOPEDICS PC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 11872 GRAVOIS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1800
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Country | US
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Telephone | 314-849-3040
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Fax | 314-849-7279
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Provider Business Mailing Address
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Address Line | 11872 GRAVOIS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1800
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Country | US
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Telephone | 314-849-3040
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Fax | 314-849-7279
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY P MULLIGAN
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Credential | DC
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Telephone | 314-849-3040
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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 | CE005086
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License Number State | MO
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