Provider Demographics
NPI:1912246950
Name:GERALD B. VANDEN HOEK D/B/A MEDICAL ALTERNATIVES OF MISSOURI
Entity type:Organization
Organization Name:GERALD B. VANDEN HOEK D/B/A MEDICAL ALTERNATIVES OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:VANDEN HOEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-299-1524
Mailing Address - Street 1:2249 SOUTH BRENTWOOD BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144
Mailing Address - Country:US
Mailing Address - Phone:314-299-1524
Mailing Address - Fax:
Practice Address - Street 1:2249 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1834
Practice Address - Country:US
Practice Address - Phone:314-299-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11466743OtherCAQH NUMBER
MO11466743OtherCAQH