# INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER O

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** IMAC Regeneration Center of St. Louis
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306203096
- **Authorized official:** THERESA LUECKE (HUMAN RESOURCES)
- **Authorized official phone:** (270) 554-5114

## Contact information

- **Practice address:** 13353 OLIVE BLVD, CHESTERFIELD, MO 63017-3108
- **Practice address phone:** (314) 200-4955
- **Practice address fax:** (314) 682-6001
- **Mailing address:** 2725 JAMES SANDERS BLVD, SUITE A, PADUCAH, KY 42001-8401
- **Mailing address phone:** (314) 200-4955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 111NX0800X | Orthopedic Chiropractor | — | NULL | — |
| 111NX0800X | Orthopedic Chiropractor | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225700000X | Massage Therapist | — | NULL | — |
| 225700000X | Massage Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 227800000X | Certified Respiratory Therapist | — | NULL | — |
| 227800000X | Certified Respiratory Therapist | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |
| 363LX0106X | Occupational Health Nurse Practitioner | — | NULL | — |
| 363LX0106X | Occupational Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/26/2016
- **Last updated:** 08/19/2020