Provider Demographics
NPI:1548686025
Name:CORE CONCEPTS CHIROPRACTIC
Entity type:Organization
Organization Name:CORE CONCEPTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:TL
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-244-5223
Mailing Address - Street 1:107 OLYMPIC WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1664
Mailing Address - Country:US
Mailing Address - Phone:636-244-5223
Mailing Address - Fax:636-244-5224
Practice Address - Street 1:107 OLYMPIC WAY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1664
Practice Address - Country:US
Practice Address - Phone:636-244-5223
Practice Address - Fax:636-244-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-08
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty