Provider Demographics
NPI:1780839944
Name:INCHIOSTRO CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:INCHIOSTRO CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:INCHIOSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-300-8089
Mailing Address - Street 1:1043A WOLFRUM RD
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7625
Mailing Address - Country:US
Mailing Address - Phone:636-300-8089
Mailing Address - Fax:636-300-8049
Practice Address - Street 1:1043A WOLFRUM RD
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-7625
Practice Address - Country:US
Practice Address - Phone:636-300-8089
Practice Address - Fax:636-300-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031866Medicare PIN