Organization
ICONIC SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE B CORDERO (MANAGER)
(314) 437-8932
Entity
Organization
Contact information
Practice address
4625 LINDELL BLVD STE 200, SAINT LOUIS, MO 63108-3729
(314) 437-8932
(888) 749-2228
Mailing address
4625 LINDELL BLVD STE 200, SAINT LOUIS, MO 63108-3729
(314) 437-8932
(888) 749-2228
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
05/21/2018
Last updated
05/21/2018
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