Provider Demographics
NPI:1700955663
Name:MISTRETTA, FRANK J (DC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:MISTRETTA
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 1:11229 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1122
Mailing Address - Country:US
Mailing Address - Phone:314-966-4300
Mailing Address - Fax:314-966-6694
Practice Address - Street 1:11229 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1122
Practice Address - Country:US
Practice Address - Phone:314-966-4300
Practice Address - Fax:314-966-6694
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14636OtherBLUE CROSS
MO3030OtherEPOCH
MO3030OtherEPOCH
MO000032024Medicare ID - Type Unspecified