Organization
MIDWEST SPINE & SPORT CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTI KAY DIECKMANN D.C., M.S. (OWNER)
(618) 973-5522
Entity
Organization
Contact information
Practice address
1210 PARAGON DR, SUITE 1B, O FALLON, IL 62269-1773
(618) 973-5522
Mailing address
1210 PARAGON DR, SUITE 1B, O FALLON, IL 62269-1773
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
038.011634
IL
Other
Enumeration date
06/14/2010
Last updated
06/14/2010
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