Provider Demographics
NPI:1720213671
Name:ALLCARE CHIROPRACTIC OF SOUTH COUNTY, P.C.
Entity Type:Organization
Organization Name:ALLCARE CHIROPRACTIC OF SOUTH COUNTY, P.C.
Other - Org Name:WELLNESSONE CHIROPRACTIC OF SOUTH COUNTY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-849-5990
Mailing Address - Street 1:13080 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3442
Mailing Address - Country:US
Mailing Address - Phone:314-849-5990
Mailing Address - Fax:314-849-3813
Practice Address - Street 1:13080 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3442
Practice Address - Country:US
Practice Address - Phone:314-849-5990
Practice Address - Fax:314-849-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43437Medicare UPIN
MO000031737Medicare PIN