MEDICARE: MATTINGLY CHIROPRACTIC

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	2003002102	MO

General Provider Information

NPI Number	:	1578617056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTINGLY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	6411 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2104
Country	:	US
Telephone Number	:	314-352-3345
Fax Number	:	314-352-3460

Provider Business Practice Location Address
First Line	:	6411 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2104
Country	:	US
Telephone Number	:	314-352-3345
Fax Number	:	314-352-3460

Authorized Official
Title or Position	:	PRODUCTION MANAGER
Name	:	MR. RYAN RICHARD FREELAND
Credential	:
Telephone Number	:	314-352-3345

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	11/29/2007

Similar Medicare Providers

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Practice Location Address:

6451 CHIPPEWA ST , STE 2
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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

6451 CHIPPEWA ST
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Practice Fax:

1154404879 — DR. LESTER C JOERN JR. D.D.S.
Practice Location Address:

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Directions to “MATTINGLY CHIROPRACTIC ” Practice Location

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