MEDICARE: DR. CRYSTAL B PEAIRS 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	2004024604	MO

General Provider Information

NPI Number	:	1467407304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL B PEAIRS D.C.

Provider Business Mailing Address
First Line	:	1013 S 18TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2909
Country	:	US
Telephone Number	:	314-436-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 S 18TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2909
Country	:	US
Telephone Number	:	314-436-3050
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	12/21/2024

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