Provider Demographics
NPI:1780915637
Name:ST. ROBERT CHIROPRACTIC CENTER, INC
Entity type:Organization
Organization Name:ST. ROBERT CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMPLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-336-2230
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-0797
Mailing Address - Country:US
Mailing Address - Phone:573-336-2230
Mailing Address - Fax:573-336-4285
Practice Address - Street 1:1106 OLD ROUTE 66
Practice Address - Street 2:SUITE 2D
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4601
Practice Address - Country:US
Practice Address - Phone:573-336-2230
Practice Address - Fax:573-336-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE06439261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
350054388OtherRAILROAD MEDICRE
U63352Medicare UPIN
000031874Medicare PIN