Provider Demographics
NPI:1235377144
Name:CHOI, CLIFFORD KRISDA (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:KRISDA
Last Name:CHOI
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 1:352 WATFORD DR
Mailing Address - Street 2:APT A
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-5022
Mailing Address - Country:US
Mailing Address - Phone:314-422-8877
Mailing Address - Fax:
Practice Address - Street 1:11705 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1803
Practice Address - Country:US
Practice Address - Phone:314-422-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor