Provider Demographics
NPI:1093949323
Name:ENVE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ENVE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, RN
Authorized Official - Phone:314-831-8877
Mailing Address - Street 1:3533 DUNN RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6761
Mailing Address - Country:US
Mailing Address - Phone:314-831-8877
Mailing Address - Fax:314-831-8874
Practice Address - Street 1:3533 DUNN RD
Practice Address - Street 2:SUITE 236
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6761
Practice Address - Country:US
Practice Address - Phone:314-831-8877
Practice Address - Fax:314-831-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009011878261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service