Provider Demographics
NPI:1912379769
Name:KINETIC CARE CHIROPRACTIC & REHABILITATION, LLC
Entity Type:Organization
Organization Name:KINETIC CARE CHIROPRACTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-401-1767
Mailing Address - Street 1:511 SALT LICK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1288
Mailing Address - Country:US
Mailing Address - Phone:618-401-1767
Mailing Address - Fax:
Practice Address - Street 1:511 SALT LICK RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1288
Practice Address - Country:US
Practice Address - Phone:618-401-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015015035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty