Dr Tracy Lynn Edelmann, DC | |
8229 Clayton Rd, Ste 204, Saint Louis, MO 63117-1155 | |
(314) 991-5655 | |
Not Available |
Full Name | Dr Tracy Lynn Edelmann |
---|---|
Gender | Female |
Speciality | Chiropractor |
Location | 8229 Clayton Rd, Saint Louis, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1508996166 | NPI | - | NPPES |
MA3182 | Other | MO | MEDICARE PTAN |
188898 | Other | MO | ANTHEM BLUE CROSS |
MA3182001 | Other | MO | MEDICARE PTAN |
43-1752340 | Other | MO | FED ID NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 006482 (Missouri) | Primary |
Provider Name | Wildwood Chiropractic, Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1437371234 PECOS PAC ID: 5395928618 Enrollment ID: O20110324000292 |
Mailing Address | Practice Location Address |
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Dr Tracy Lynn Edelmann, DC 8229 Clayton Rd, Ste 204, Saint Louis, MO 63117-1155 Ph: (314) 991-5655 | Dr Tracy Lynn Edelmann, DC 8229 Clayton Rd, Ste 204, Saint Louis, MO 63117-1155 Ph: (314) 991-5655 |
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