Provider Demographics
NPI:1205848579
Name:MCINTYRE CHIROPRACTIC & ACUPUNCTURE CENTRE, LLC
Entity Type:Organization
Organization Name:MCINTYRE CHIROPRACTIC & ACUPUNCTURE CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-644-7776
Mailing Address - Street 1:1415 S BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2203
Mailing Address - Country:US
Mailing Address - Phone:314-644-7776
Mailing Address - Fax:
Practice Address - Street 1:1415 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2203
Practice Address - Country:US
Practice Address - Phone:314-644-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU05432Medicare UPIN
MO000032170Medicare PIN
MO990001755Medicare PIN