Provider Demographics
NPI:1467564781
Name:CITRIN CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CITRIN CHIROPRACTIC CENTER PC
Other - Org Name:CITRIN CHIROPRACTIC CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CITRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-890-2400
Mailing Address - Street 1:10035 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-890-2400
Mailing Address - Fax:314-890-2410
Practice Address - Street 1:10035 PAGE AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-890-2400
Practice Address - Fax:314-890-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132037OtherBLUE CROSS GROUP
MO157640OtherANTHEM
=========OtherTAX ID
MO132037OtherBLUE CROSS GROUP
MO000030683Medicare PIN