Provider Demographics
NPI:1588851935
Name:ST LOUIS SPORTS CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:ST LOUIS SPORTS CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-843-8590
Mailing Address - Street 1:12032 TESSON FERRY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1774
Mailing Address - Country:US
Mailing Address - Phone:314-843-8590
Mailing Address - Fax:314-842-9899
Practice Address - Street 1:12032 TESSON FERRY RD
Practice Address - Street 2:STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1774
Practice Address - Country:US
Practice Address - Phone:314-843-8590
Practice Address - Fax:314-842-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty