Provider Demographics
NPI:1356584460
Name:CROSSROADS FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:CROSSROADS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-740-7421
Mailing Address - Street 1:12324 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6443
Mailing Address - Country:US
Mailing Address - Phone:314-439-0777
Mailing Address - Fax:314-439-0166
Practice Address - Street 1:12324 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6443
Practice Address - Country:US
Practice Address - Phone:314-439-0777
Practice Address - Fax:314-439-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009001513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty