Provider Demographics
NPI:1568876456
Name:SMART PAIN SOLUTIONS
Entity Type:Organization
Organization Name:SMART PAIN SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDEL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:314-298-1400
Mailing Address - Street 1:11901 ST. CHARLES ROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2623
Mailing Address - Country:US
Mailing Address - Phone:314-298-1400
Mailing Address - Fax:314-298-1401
Practice Address - Street 1:2431 NORTH GRAND BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1018
Practice Address - Country:US
Practice Address - Phone:314-298-1400
Practice Address - Fax:314-298-1401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMART PAIN SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200827070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty