Provider Demographics
NPI:1154822112
Name:PILGRIM, MATHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:PILGRIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2077
Mailing Address - Country:US
Mailing Address - Phone:636-937-9200
Mailing Address - Fax:636-937-0900
Practice Address - Street 1:620 COLLINS DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-937-9200
Practice Address - Fax:636-937-0900
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018005297111NR0400X, 111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor