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DR. GREGORY WADE EDSTROM D.C.

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1447389119

Individual Registrant:
DR. GREGORY WADE EDSTROM D.C.
Gender: M
Sole Proprietor

Location and contact information for practice:
5714 S LINDBERGH BLVD #7 AFFTON, MO 63123-6955 US
Tel: 314-842-4929  Fax: 314-842-1829

Contact information for business:
5714 S LINDBERGH BLVD #7 AFFTON, MO 63123-6955 US
Tel: 314-842-4929  Fax: 314-842-1829

Registration Information:
NPI: 1447389119
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
MO03699

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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