MEDICARE: RIVERTOWNE FAMILY CHIROPRACTIC, LLC

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	006118	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4668026	OTHER	MO	AETNA PIN - DR. BICKMEYER
2	4728	OTHER	MO	ANTHEM ID - DR. BICKMEYER
3	7986711	OTHER	MO	AETNA PIN - DR. LOCK
4	205255	OTHER	MO	DR. LOCK ANTHEM ID

General Provider Information

NPI Number	:	1548273725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERTOWNE FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1362 S 5TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2444
Country	:	US
Telephone Number	:	636-947-7463
Fax Number	:	636-947-7177

Provider Business Practice Location Address
First Line	:	1362 S 5TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2444
Country	:	US
Telephone Number	:	636-947-7463
Fax Number	:	636-947-7177

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD CLARK BICKMEYER
Credential	:	D.C.
Telephone Number	:	636-947-7463

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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Directions to “RIVERTOWNE FAMILY CHIROPRACTIC, LLC ” Practice Location

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