MEDICARE: DR. JULIANNE CHRISTINE THAKE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2014038935	MO

General Provider Information

NPI Number	:	1083039929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIANNE CHRISTINE THAKE D.C.

Provider Business Mailing Address
First Line	:	25 PARK PL
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-3146
Country	:	US
Telephone Number	:	330-265-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 SAINT PETERS HOWELL RD
Second Line	:	STE J
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2821
Country	:	US
Telephone Number	:	636-248-9561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2014
Last Update Date	:	01/05/2017

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