Provider Demographics
NPI:1093904856
Name:MINNER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MINNER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:MINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-570-1952
Mailing Address - Street 1:4245 OLD HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5714
Mailing Address - Country:US
Mailing Address - Phone:314-570-1952
Mailing Address - Fax:
Practice Address - Street 1:902 E 6TH ST
Practice Address - Street 2:STE. B
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3111
Practice Address - Country:US
Practice Address - Phone:636-239-9997
Practice Address - Fax:636-239-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015480Medicare PIN