Provider Demographics
NPI:1346576709
Name:THE YOUTHFUL BODY, INC.
Entity Type:Organization
Organization Name:THE YOUTHFUL BODY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-692-2639
Mailing Address - Street 1:10287 CLAYTON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LADUE
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1172
Mailing Address - Country:US
Mailing Address - Phone:314-692-2639
Mailing Address - Fax:314-692-2649
Practice Address - Street 1:10287 CLAYTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1172
Practice Address - Country:US
Practice Address - Phone:314-692-2639
Practice Address - Fax:314-692-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty