Provider Demographics
NPI:1720413065
Name:ESTRADA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ESTRADA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANGELICA
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-276-7499
Mailing Address - Street 1:6842 WALDEMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3556
Mailing Address - Country:US
Mailing Address - Phone:314-276-7499
Mailing Address - Fax:
Practice Address - Street 1:23 N GORE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2300
Practice Address - Country:US
Practice Address - Phone:314-961-7605
Practice Address - Fax:314-961-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty