Provider Demographics
NPI:1053515957
Name:DYNAMIC HEALTH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DYNAMIC HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-496-8044
Mailing Address - Street 1:510 BAXTER RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7032
Mailing Address - Country:US
Mailing Address - Phone:636-207-6600
Mailing Address - Fax:636-207-6631
Practice Address - Street 1:510 BAXTER RD
Practice Address - Street 2:SUITE #8
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7032
Practice Address - Country:US
Practice Address - Phone:636-207-6600
Practice Address - Fax:636-207-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001011188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty