Organization
DIVAN CHIROPRACTIC AND SPORTS REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANA WILLISON (OFFICE MANAGER)
(314) 961-7181
Entity
Organization
Contact information
Practice address
8045 BIG BEND BLVD, 107, SAINT LOUIS, MO 63119-2714
(314) 961-7181
Mailing address
8045 BIG BEND BLVD, SUITE 107, SAINT LOUIS, MO 63119-2714
(314) 961-7181
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2014010441
MO
Other
Enumeration date
12/29/2014
Last updated
12/29/2014
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