Provider Demographics
NPI:1689891947
Name:MENARD, STEVEN SCOTT (DC, FIAMA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SCOTT
Last Name:MENARD
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W BROADWAY
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3842
Mailing Address - Country:US
Mailing Address - Phone:573-443-3400
Mailing Address - Fax:573-443-3402
Practice Address - Street 1:201 W BROADWAY
Practice Address - Street 2:SUITE 3E
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3842
Practice Address - Country:US
Practice Address - Phone:573-443-3400
Practice Address - Fax:573-443-3402
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001023791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO167437OtherBCBS
MOU83393Medicare UPIN