# MIDWEST SPINE & SPORT CHIROPRACTIC

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

## Provider details

- **NPI number:** 1336460385
- **Authorized official:** DR. KRISTI KAY DIECKMANN D.C., M.S. (OWNER)
- **Authorized official phone:** (618) 973-5522

## Contact information

- **Practice address:** 1210 PARAGON DR, SUITE 1B, O FALLON, IL 62269-1773
- **Practice address phone:** (618) 973-5522
- **Mailing address:** 1210 PARAGON DR, SUITE 1B, O FALLON, IL 62269-1773

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 038.011634 | IL | Yes |

## Other

- **Enumeration date:** 06/14/2010
- **Last updated:** 06/14/2010