Provider Demographics
NPI:1114155587
Name:LUNA WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:LUNA WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-780-7820
Mailing Address - Street 1:2001 S HANLEY RD
Mailing Address - Street 2:STE 250
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1518
Mailing Address - Country:US
Mailing Address - Phone:314-780-7820
Mailing Address - Fax:314-644-7727
Practice Address - Street 1:2001 S HANLEY RD
Practice Address - Street 2:STE 250
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1518
Practice Address - Country:US
Practice Address - Phone:314-780-7820
Practice Address - Fax:314-644-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011410111N00000X, 111NN1001X
MO200823938111N00000X
FLCH9684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty