Provider Demographics
NPI:1326316225
Name:CHIROPRACTIC SPECIALIST,LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC SPECIALIST,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-236-5126
Mailing Address - Street 1:3533 DUNN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6761
Mailing Address - Country:US
Mailing Address - Phone:636-236-5126
Mailing Address - Fax:
Practice Address - Street 1:3533 DUNN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6761
Practice Address - Country:US
Practice Address - Phone:636-236-5126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty