Provider Demographics
NPI:1770818114
Name:KLOSTERMANN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KLOSTERMANN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLOSTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-843-3900
Mailing Address - Street 1:3828 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1366
Mailing Address - Country:US
Mailing Address - Phone:314-843-3900
Mailing Address - Fax:314-842-9884
Practice Address - Street 1:3828 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1366
Practice Address - Country:US
Practice Address - Phone:314-843-3900
Practice Address - Fax:314-842-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009026112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty