Provider Demographics
NPI:1063718732
Name:DECLUE, DAVID CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:DECLUE
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 1:1195 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4415
Mailing Address - Country:US
Mailing Address - Phone:314-607-1973
Mailing Address - Fax:
Practice Address - Street 1:2315 TECHNOLOGY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7370
Practice Address - Country:US
Practice Address - Phone:314-607-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor