Organization
ORTHOPEDIC AND SPINE INSTITUTE OF ST. LOUIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE R DICKISON RN (PRACTICE ADMINISTRATOR)
(314) 808-3173
Entity
Organization
Contact information
Practice address
10435 CLAYTON RD, STE 120, SAINT LOUIS, MO 63131
(314) 442-4452
(866) 216-3928
Mailing address
10435 CLAYTON RD STE 120, SAINT LOUIS, MO 63131-2930
(314) 442-4452
(866) 216-3928
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Enumeration date
10/26/2017
Last updated
02/07/2019
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