Organization
BRENTWOOD PAINSTOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS J DIVAN DC (CHIROPRACTOR)
(314) 961-7181
Entity
Organization
Contact information
Practice address
8045 BIG BEND BLVD STE 107, SAINT LOUIS, MO 63119-2714
(314) 961-7181
Mailing address
8045 BIG BEND BLVD STE 107, SAINT LOUIS, MO 63119-2714
(314) 961-7181
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
2014010441
MO
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
2014010441
MO
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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