Provider Demographics
NPI:1194909887
Name:CRANWELL CHIROPRACTIC
Entity type:Organization
Organization Name:CRANWELL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CRANWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-843-3039
Mailing Address - Street 1:11705 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1803
Mailing Address - Country:US
Mailing Address - Phone:314-843-3039
Mailing Address - Fax:314-843-9604
Practice Address - Street 1:11705 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1803
Practice Address - Country:US
Practice Address - Phone:314-843-3039
Practice Address - Fax:314-843-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO03791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty