Provider Demographics
NPI:1942494976
Name:KLEINSCHMIDT, GREGORY FOSTER (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:FOSTER
Last Name:KLEINSCHMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 SUTTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3036
Mailing Address - Country:US
Mailing Address - Phone:314-440-1662
Mailing Address - Fax:
Practice Address - Street 1:2716 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3036
Practice Address - Country:US
Practice Address - Phone:314-440-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007026614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor