MEDICARE: HEATHER MARIE MCQUEEN

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	2023016398	MO

General Provider Information

NPI Number	:	1770261687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE MCQUEEN

Provider Business Mailing Address
First Line	:	11777 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1822
Country	:	US
Telephone Number	:	314-690-7779
Fax Number	:	314-208-3050

Provider Business Practice Location Address
First Line	:	11777 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1822
Country	:	US
Telephone Number	:	314-690-7779
Fax Number	:	314-208-3050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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Directions to “ HEATHER MARIE MCQUEEN ” Practice Location

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