MEDICARE: SPINAL CARE CONCEPTS, P.C.

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	2004011261	MO

General Provider Information

NPI Number	:	1912116815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL CARE CONCEPTS, P.C.

Provider Business Mailing Address
First Line	:	2303 MCKELVEY RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1531
Country	:	US
Telephone Number	:	314-878-9355
Fax Number	:	314-878-7219

Provider Business Practice Location Address
First Line	:	2303 MCKELVEY RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1531
Country	:	US
Telephone Number	:	314-878-9355
Fax Number	:	314-878-7219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADAM WILLIAM BALOG
Credential	:	D.C.
Telephone Number	:	314-878-9355

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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