Individual
EDWARD JOHNNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1137 N MAIN ST STE 1, O FALLON, MO 63366-1498
(636) 294-4530
Mailing address
1548 WAINSCOTT DR, O FALLON, MO 63366-4481
(636) 734-7569
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2000146684
MO
Other
Enumeration date
06/30/2006
Last updated
03/02/2020
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