Provider Demographics
NPI:1760038392
Name:MELISSA GEORGEVITCH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MELISSA GEORGEVITCH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GEORGEVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-681-3221
Mailing Address - Street 1:1709 W HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1849
Mailing Address - Country:US
Mailing Address - Phone:314-681-3221
Mailing Address - Fax:
Practice Address - Street 1:724 W OSAGE ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1219
Practice Address - Country:US
Practice Address - Phone:636-422-0174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service