Provider Demographics
NPI:1215112040
Name:KOELLING & TURNBULL CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:KOELLING & TURNBULL CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOELLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-477-6100
Mailing Address - Street 1:1345 QUEENS CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7356
Mailing Address - Country:US
Mailing Address - Phone:636-477-6100
Mailing Address - Fax:636-477-7287
Practice Address - Street 1:1345 QUEENS CT
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7356
Practice Address - Country:US
Practice Address - Phone:636-477-6100
Practice Address - Fax:636-477-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005857111NS0005X
MO006014111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001553Medicare PIN