Provider Demographics
NPI:1215067186
Name:WESTPORT PAIN CENTER
Entity type:Organization
Organization Name:WESTPORT PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR-DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-469-8500
Mailing Address - Street 1:929 FEE FEE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3807
Mailing Address - Country:US
Mailing Address - Phone:314-469-9843
Mailing Address - Fax:
Practice Address - Street 1:929 FEE FEE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3807
Practice Address - Country:US
Practice Address - Phone:314-469-9843
Practice Address - Fax:314-439-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty