# ICONIC SERVICES INC

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

## Provider details

- **NPI number:** 1750872354
- **Authorized official:** CHRISTINE B CORDERO (MANAGER)
- **Authorized official phone:** (314) 437-8932

## Contact information

- **Practice address:** 4625 LINDELL BLVD STE 200, SAINT LOUIS, MO 63108-3729
- **Practice address phone:** (314) 437-8932
- **Practice address fax:** (888) 749-2228
- **Mailing address:** 4625 LINDELL BLVD STE 200, SAINT LOUIS, MO 63108-3729
- **Mailing address phone:** (314) 437-8932
- **Mailing address fax:** (888) 749-2228

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/21/2018
- **Last updated:** 05/21/2018