Provider Demographics
NPI:1821429077
Name:PROFICIENT CHIROPRACTIC HOLDINGS LLC
Entity Type:Organization
Organization Name:PROFICIENT CHIROPRACTIC HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:314-276-4154
Mailing Address - Street 1:10251 LINCOLN TRL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1846
Mailing Address - Country:US
Mailing Address - Phone:314-276-4154
Mailing Address - Fax:314-447-0726
Practice Address - Street 1:2050 WOODSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5644
Practice Address - Country:US
Practice Address - Phone:314-276-4154
Practice Address - Fax:314-447-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty