Provider Demographics
NPI:1740253038
Name:COMPREHENSIVE CHIROPRACTIC PC
Entity type:Organization
Organization Name:COMPREHENSIVE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-938-9310
Mailing Address - Street 1:113 WEST 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025
Mailing Address - Country:US
Mailing Address - Phone:636-938-9310
Mailing Address - Fax:636-938-3204
Practice Address - Street 1:113 WEST 5TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025
Practice Address - Country:US
Practice Address - Phone:636-938-9310
Practice Address - Fax:636-938-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU67511OtherMERCY
MO143427OtherGHP
MO1941775OtherPHCS
MO106922OtherBLUE CROSS BLUE SHIELD
DD9391OtherMEDICARE RAILROAD
MO1003910OtherASHN
MO5538504OtherAETNA
MO669258OtherHEALTHLINK