Provider Demographics
NPI:1407266596
Name:MUNRO, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MUNRO
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 1:14500 S OUTER 40 RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5780
Mailing Address - Country:US
Mailing Address - Phone:314-485-8058
Mailing Address - Fax:314-720-1831
Practice Address - Street 1:14500 S OUTER 40 RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-5780
Practice Address - Country:US
Practice Address - Phone:314-485-8058
Practice Address - Fax:314-720-1831
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014001983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor