Provider Demographics
NPI:1538295290
Name:SEYMOUR, CAROLINE ANNE (DC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ANNE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4187 CRESCENT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1098
Mailing Address - Country:US
Mailing Address - Phone:314-892-4101
Mailing Address - Fax:314-892-4120
Practice Address - Street 1:4187 CRESCENT DR
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1098
Practice Address - Country:US
Practice Address - Phone:314-892-4101
Practice Address - Fax:314-892-4120
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001020199111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO174832OtherANTHEM BLUE CROSS BLUE SH
MO000013932Medicare ID - Type Unspecified