| NPI | 1225548290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS J DIVAN Chiropractor 314-961-7181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2014010441) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MO 2014010441) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2017-10-04 |