MEDICARE: CHIROPRACTIC CENTRE OF CRESTWOOD INC.

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	111NX0800X	Orthopedic Chiropractor	004518	MO

General Provider Information

NPI Number	:	1821363037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CENTRE OF CRESTWOOD INC.

Provider Business Mailing Address
First Line	:	9109 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2235
Country	:	US
Telephone Number	:	314-961-4101
Fax Number	:	314-961-1886

Provider Business Practice Location Address
First Line	:	9109 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2235
Country	:	US
Telephone Number	:	314-961-4101
Fax Number	:	314-961-1886

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY W CALANDRO
Credential	:	DC
Telephone Number	:	314-961-4101

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	04/03/2012

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