Organization
CHIROPRACTIC ACCIDENT CENTER OF FENTON, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESA NOLAN (OFFICE MANAGER)
(636) 343-9595
Entity
Organization
Contact information
Practice address
408 GRAVOIS RD, FENTON, MO 63026-4133
(636) 343-9595
(636) 343-8126
Mailing address
408 GRAVOIS RD, FENTON, MO 63026-4133
(636) 343-9595
(636) 343-8126
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
005984
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17425
ANTHEM BLUE CROSS BLUE SH
MO
Enumeration date
03/28/2007
Last updated
06/28/2018
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