Provider Demographics
NPI:1003292939
Name:BUELTMANN CHIROPRACTIC
Entity Type:Organization
Organization Name:BUELTMANN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-346-6822
Mailing Address - Street 1:7040 DARTMOUTH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2314
Mailing Address - Country:US
Mailing Address - Phone:314-346-6822
Mailing Address - Fax:
Practice Address - Street 1:11705 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1803
Practice Address - Country:US
Practice Address - Phone:314-346-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015001855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty