Provider Demographics
NPI:1992982946
Name:DONALD S. KREIDLER CHIROPRACTIC, PC
Entity type:Organization
Organization Name:DONALD S. KREIDLER CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KREIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-298-1400
Mailing Address - Street 1:11901 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2623
Mailing Address - Country:US
Mailing Address - Phone:314-298-1400
Mailing Address - Fax:314-298-1401
Practice Address - Street 1:11901 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2623
Practice Address - Country:US
Practice Address - Phone:314-298-1400
Practice Address - Fax:314-298-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005517111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty