MEDICARE: CHIROPRACTIC CENTRE-OLIVE/270,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	111NS0005X	Sports Physician Chiropractor	CE005091	MO

General Provider Information

NPI Number	:	1548421282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CENTRE-OLIVE/270,LLC

Provider Business Mailing Address
First Line	:	11935 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6729
Country	:	US
Telephone Number	:	314-432-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	11935 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6729
Country	:	US
Telephone Number	:	314-432-5899
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR AND OWNER
Name	:	DR. RHONDA L JONES
Credential	:	DC
Telephone Number	:	314-432-0005

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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