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Organization
KINESIOLOGY CENTER OF GREATER ST LOUIS INC
Active
Organization
KINESIOLOGY CENTER OF GREATER ST LOUIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHARINE M CONABLE DC (VICE PRESIDENT)
(314) 991-5655
Entity
Organization
Contact information
Practice address
608 NO MCKNIGHT RD, ST LOUIS, MO 63132-4911
(314) 991-5655
(314) 991-4872
Mailing address
8229 CLAYTON RD, SUITE 204, SAINT LOUIS, MO 63117-1155
(314) 991-5655
(314) 532-5080
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3930
MO
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
084723
HEALTH ALLIANCE
—
01
—
10146X
EMPIRE BLUE CROSS
—
01
—
10315X
EMPIRE BLUE CROSS
—
01
—
178246
HEALTHLINK
—
01
—
179148
HEALTHLINK
—
01
—
350045267
RAILROAD MEDICARE
—
01
—
3930
MISSOURI LICENSE
—
01
—
4327678
AETNA
—
01
—
4582036
AETNA
—
01
—
57883
GROUP HEALTH PLAN
—
01
—
7412
BLUE CROSS BS OF MO
—
01
—
990001765
RR MEDICARE GROUP PIN
—
Enumeration date
07/14/2006
Last updated
03/27/2014
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