# BRENTWOOD PAINSTOP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225548290
- **Authorized official:** NICHOLAS J DIVAN DC (CHIROPRACTOR)
- **Authorized official phone:** (314) 961-7181

## Contact information

- **Practice address:** 8045 BIG BEND BLVD STE 107, SAINT LOUIS, MO 63119-2714
- **Practice address phone:** (314) 961-7181
- **Mailing address:** 8045 BIG BEND BLVD STE 107, SAINT LOUIS, MO 63119-2714
- **Mailing address phone:** (314) 961-7181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | 2014010441 | MO | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 2014010441 | MO | Yes |

## Other

- **Enumeration date:** 10/04/2017
- **Last updated:** 10/04/2017