Provider Demographics
NPI:1770090425
Name:NORTH, JULIA (DC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:NORTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 TRIAD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7352
Mailing Address - Country:US
Mailing Address - Phone:636-477-8885
Mailing Address - Fax:
Practice Address - Street 1:1365 TRIAD CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7352
Practice Address - Country:US
Practice Address - Phone:636-477-8885
Practice Address - Fax:502-245-7334
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5560111N00000X
MO2020040059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO830092018Medicaid