MEDICARE: SMART PAIN SOLUTIONS

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	200827070	MO

General Provider Information

NPI Number	:	1568876456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART PAIN SOLUTIONS

Provider Business Mailing Address
First Line	:	11901 ST. CHARLES ROCK ROAD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2623
Country	:	US
Telephone Number	:	314-298-1400
Fax Number	:	314-298-1401

Provider Business Practice Location Address
First Line	:	2431 NORTH GRAND BLVD.
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63106-1018
Country	:	US
Telephone Number	:	314-298-1400
Fax Number	:	314-298-1401

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT F. ANDEL III
Credential	:	D.C.
Telephone Number	:	314-298-1400

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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Directions to “SMART PAIN SOLUTIONS ” Practice Location

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