MEDICARE: CONVERGENCE CHIROPRACTIC CLINIC, 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

General Provider Information

NPI Number	:	1609638295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVERGENCE CHIROPRACTIC CLINIC, LLC

Provider Business Mailing Address
First Line	:	8044 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2818
Country	:	US
Telephone Number	:	314-707-9854
Fax Number	:

Provider Business Practice Location Address
First Line	:	8044 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2818
Country	:	US
Telephone Number	:	314-707-9854
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DR. JOEL CARTER MAIER
Credential	:	DC
Telephone Number	:	314-707-9854

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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