| Wilmington Chiropractic Clinic, Llc | |
|
4918 Weber Rd Saint Louis MO 63123-5645 | |
| (314) 353-1477 | |
| (314) 631-3060 |
| Full Name | Wilmington Chiropractic Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4918 Weber Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Michael Fiscella (OWNER) |
| Authorized Official Contact | 3143531477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilmington Chiropractic Clinic, Llc 4918 Weber Rd Saint Louis MO 63123-5645 Ph: (314) 353-1477 | Wilmington Chiropractic Clinic, Llc 4918 Weber Rd Saint Louis MO 63123-5645 Ph: (314) 353-1477 |
| NPI Number | 1609383900 |
|---|---|
| Provider Enumeration Date | 01/08/2018 |
| Last Update Date | 01/08/2018 |
| Medicare PECOS PAC ID | 9032478003 |
|---|---|
| Medicare Enrollment ID | O20180119001473 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609383900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 004167 (Missouri) | Primary |
| Provider Name | Michael J Fiscella |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1548295215 PECOS PAC ID: 8224138748 Enrollment ID: I20070713000107 |
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