Provider Demographics
NPI:1942480256
Name:ST. LOUIS SPINE & HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:ST. LOUIS SPINE & HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTON
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:NEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-576-1495
Mailing Address - Street 1:12401 OLIVE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5448
Mailing Address - Country:US
Mailing Address - Phone:314-576-1495
Mailing Address - Fax:314-576-2804
Practice Address - Street 1:12401 OLIVE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5448
Practice Address - Country:US
Practice Address - Phone:314-576-1495
Practice Address - Fax:314-576-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
155354OtherDESERET MUTUAL
20189OtherANTHEM
285150OtherGHP
350056741OtherRAILROAD MEDICARE
1275529745OtherNPI
1130904OtherFIRST HEALTH
4403250OtherUNITED HEALTHCARE
633007106OtherPHCS
U5 1010Medicare UPIN
285150OtherGHP