Provider Demographics
NPI:1821232224
Name:ESQUIRE CLINIC INC.
Entity Type:Organization
Organization Name:ESQUIRE CLINIC INC.
Other - Org Name:ESQUIRE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICHTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-644-0885
Mailing Address - Street 1:1201 S BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1645
Mailing Address - Country:US
Mailing Address - Phone:314-644-0885
Mailing Address - Fax:314-644-5836
Practice Address - Street 1:1201 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1645
Practice Address - Country:US
Practice Address - Phone:314-644-0885
Practice Address - Fax:314-644-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT80974Medicare UPIN