Provider Demographics
NPI:1396854360
Name:SPAHN, PAUL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:SPAHN
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 1:2621 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4872
Mailing Address - Country:US
Mailing Address - Phone:636-946-2244
Mailing Address - Fax:636-946-6975
Practice Address - Street 1:2621 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4872
Practice Address - Country:US
Practice Address - Phone:636-946-2244
Practice Address - Fax:636-946-6975
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43510Medicare UPIN