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DR. GREGORY WADE EDSTROM D.C.
>> Chiropractor >> Chiropractic ProvidersRegistrant NPI Number: 1447389119
Individual Registrant:DR. GREGORY WADE EDSTROM D.C.
Gender: M
Sole Proprietor
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
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
Tel: 314-842-4929 Fax: 314-842-1829
Registration Information:
NPI: 1447389119
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 111N00000X | Chiropractic Providers Chiropractor | MO | 03699 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
