MEDICARE: ACCIDENT AND INJURY CENTER OF NORTH COUNTY PC

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	2001017247	MO

General Provider Information

NPI Number	:	1942544010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCIDENT AND INJURY CENTER OF NORTH COUNTY PC

Provider Business Mailing Address
First Line	:	11405 NEW HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7031
Country	:	US
Telephone Number	:	314-838-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	11405 NEW HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7031
Country	:	US
Telephone Number	:	314-838-6070
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. RICKY A ROBERTS
Credential	:	D.C.
Telephone Number	:	314-838-6070

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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