Provider Demographics
NPI:1790732642
Name:HENDRICKS CHIROPRACTIC
Entity type:Organization
Organization Name:HENDRICKS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-892-2598
Mailing Address - Street 1:2901 UNION ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125
Mailing Address - Country:US
Mailing Address - Phone:314-892-2598
Mailing Address - Fax:314-894-0157
Practice Address - Street 1:2901 UNION ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125
Practice Address - Country:US
Practice Address - Phone:314-892-2598
Practice Address - Fax:314-894-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty