MEDICARE: SOUTHWEST 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	2002005721	MO

General Provider Information

NPI Number	:	1609140854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3538 JAMIESON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2103
Country	:	US
Telephone Number	:	314-647-5047
Fax Number	:	262-546-5047

Provider Business Practice Location Address
First Line	:	3538 JAMIESON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2103
Country	:	US
Telephone Number	:	314-647-5047
Fax Number	:	262-546-5047

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT T FOY
Credential	:	D.C.
Telephone Number	:	314-647-5047

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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Directions to “SOUTHWEST FAMILY CHIROPRACTIC LLC ” Practice Location

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