Organization
ACTIVE FAMILY CHIROPRACTIC, LLC
Active
Other names
Cardinal Physical Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WAYNE BLALOCK JR. D.C. (MEMBER/MANAGER)
(636) 352-0380
Entity
Organization
Contact information
Practice address
1404 TRIAD CENTER DR, SAINT PETERS, MO 63376-7351
(636) 352-0380
(636) 352-2343
Mailing address
1404 TRIAD CENTER DR, SAINT PETERS, MO 63376-7351
(636) 352-0380
(636) 352-2343
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2011000744
MO
Other
Enumeration date
01/14/2011
Last updated
03/01/2017
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