Provider Demographics
NPI:1861843500
Name:PARADIGM HOLISTIC HEALTH CENTER
Entity Type:Organization
Organization Name:PARADIGM HOLISTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-406-4894
Mailing Address - Street 1:223 SALT LICK RD STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5974
Mailing Address - Country:US
Mailing Address - Phone:314-406-4894
Mailing Address - Fax:636-387-1397
Practice Address - Street 1:127 CALWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3561
Practice Address - Country:US
Practice Address - Phone:314-406-4894
Practice Address - Fax:636-387-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005954111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32396Medicare PIN
MOU29413Medicare UPIN