Provider Demographics
NPI:1821363037
Name:CHIROPRACTIC CENTRE OF CRESTWOOD INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTRE OF CRESTWOOD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CALANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-961-4101
Mailing Address - Street 1:9109 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2235
Mailing Address - Country:US
Mailing Address - Phone:314-961-4101
Mailing Address - Fax:314-961-1886
Practice Address - Street 1:9109 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-2235
Practice Address - Country:US
Practice Address - Phone:314-961-4101
Practice Address - Fax:314-961-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004518111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000030861Medicare PIN