MEDICARE: WEST END CHIROPRACTIC & REHAB CENTER

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	2000149199	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	164713	OTHER	MO	BLUE CROSS GROUP NUMBER

General Provider Information

NPI Number	:	1790977122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST END CHIROPRACTIC & REHAB CENTER

Provider Business Mailing Address
First Line	:	305 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1229
Country	:	US
Telephone Number	:	314-361-4650
Fax Number	:	314-361-4663

Provider Business Practice Location Address
First Line	:	305 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1229
Country	:	US
Telephone Number	:	314-361-4650
Fax Number	:	314-361-4663

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL L GERDINE
Credential	:	D.C.
Telephone Number	:	314-631-4650

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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Directions to “WEST END CHIROPRACTIC & REHAB CENTER ” Practice Location

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