Facts
- Status
- A
- Credential
- D.C.
- Type
- Individual
- Enumeration date
- 2006-11-20
- Last updated
- 2008-03-10
Specialties
Licenses
- License MO
- 5590
Location
- Practice location
- 972 KEHRS MILL RD
- City
- BALLWIN MO
- Postal code
- 630112402
- Phone
- 636-394-4101
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.