Provider Demographics
NPI:1194018408
Name:SPORTS & FAMILY CHIROPRACTIC & ACUPUNCTURE
Entity type:Organization
Organization Name:SPORTS & FAMILY CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-530-1212
Mailing Address - Street 1:10510 OLD OLIVE STREET RD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5926
Mailing Address - Country:US
Mailing Address - Phone:314-991-2295
Mailing Address - Fax:314-991-0205
Practice Address - Street 1:132 CHESTERFIELD COMMONS RD E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1440
Practice Address - Country:US
Practice Address - Phone:636-530-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty