Provider Demographics
NPI:1669578225
Name:CHESTERFIELD ORTHOPEDICS, PC
Entity type:Organization
Organization Name:CHESTERFIELD ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALENTYNOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-317-9000
Mailing Address - Street 1:222 SOUTH WOODS MILL ROAD
Mailing Address - Street 2:SUITE 650 NORTH MEDICAL BUILDING
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-317-9000
Mailing Address - Fax:314-275-8372
Practice Address - Street 1:222 SOUTH WOODS MILL ROAD
Practice Address - Street 2:SUITE 650 NORTH MEDICAL BUILDING
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-317-9000
Practice Address - Fax:314-275-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4J48207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200037794OtherRAILROAD MEDICARE
MOE57381Medicare UPIN