Provider Demographics
NPI:1932523719
Name:NATURAL BRIDGE INJURY CENTER, LLC
Entity Type:Organization
Organization Name:NATURAL BRIDGE INJURY CENTER, LLC
Other - Org Name:OLIVE STREET INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-371-2000
Mailing Address - Street 1:3303 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1114
Mailing Address - Country:US
Mailing Address - Phone:314-371-2000
Mailing Address - Fax:314-371-2001
Practice Address - Street 1:3303 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1114
Practice Address - Country:US
Practice Address - Phone:314-371-2000
Practice Address - Fax:314-371-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty