Provider Demographics
NPI:1205000106
Name:AFFTON LEMAY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:AFFTON LEMAY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-631-5550
Mailing Address - Street 1:4006 BAYLESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-1314
Mailing Address - Country:US
Mailing Address - Phone:314-631-5550
Mailing Address - Fax:
Practice Address - Street 1:4006 BAYLESS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-1314
Practice Address - Country:US
Practice Address - Phone:314-631-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33695OtherGROUP HEALTH PLAN
MO350046064OtherRAILROAD MEDICARE
MO7788OtherBLUE CROSS BLUE SHIELD
MO119883OtherANTHEM BLUE CROSS BLUE SHIELD
MO4406970OtherUNITED HEALTHCARE
MO4406970OtherUNITED HEALTHCARE