Provider Demographics
NPI:1568594232
Name:MISSOURI SPINE CARE, LLC
Entity Type:Organization
Organization Name:MISSOURI SPINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-965-5050
Mailing Address - Street 1:3555 SUNSET OFFICE DR
Mailing Address - Street 2:SUITE C110
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1015
Mailing Address - Country:US
Mailing Address - Phone:314-965-5050
Mailing Address - Fax:314-966-5565
Practice Address - Street 1:3555 SUNSET OFFICE DR
Practice Address - Street 2:SUITE C110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1015
Practice Address - Country:US
Practice Address - Phone:314-965-5050
Practice Address - Fax:314-966-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty