| NPI | 1215112040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD A KOELLING President 636-477-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MO 005857) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MO 006014) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2014-10-15 |