MEDICARE: PROFICIENT CHIROPRACTIC HOLDINGS 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		MO

General Provider Information

NPI Number	:	1821429077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFICIENT CHIROPRACTIC HOLDINGS LLC

Provider Business Mailing Address
First Line	:	10251 LINCOLN TRL
Second Line	:	SUITE 4
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1846
Country	:	US
Telephone Number	:	314-276-4154
Fax Number	:	314-447-0726

Provider Business Practice Location Address
First Line	:	2050 WOODSON RD
Second Line	:	SUITE 101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5644
Country	:	US
Telephone Number	:	314-276-4154
Fax Number	:	314-447-0726

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDGAR EVERETT III
Credential	:	DC
Telephone Number	:	314-276-4154

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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