MEDICARE: FEET FOR LIFE CENTERS INC PC

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	2010024583	MO
2	213ES0103X	Foot & Ankle Surgery Podiatrist	2012010878	MO
3	213ES0103X	Foot & Ankle Surgery Podiatrist	000603	MO

General Provider Information

NPI Number	:	1548484819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEET FOR LIFE CENTERS INC PC

Provider Business Mailing Address
First Line	:	8637 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1906
Country	:	US
Telephone Number	:	314-983-0303
Fax Number	:	314-983-2777

Provider Business Practice Location Address
First Line	:	8637 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1906
Country	:	US
Telephone Number	:	314-983-0303
Fax Number	:	314-983-2777

Authorized Official
Title or Position	:	ADMIN MANAGER
Name	:	MRS. AMEY DRAKE
Credential	:
Telephone Number	:	314-983-0303

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	06/27/2022

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Directions to “FEET FOR LIFE CENTERS INC PC ” Practice Location

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