| Ezell Chiropractic Llc | |
|
2201 1st Capitol Dr Saint Charles MO 63301-5805 | |
| (636) 916-0660 | |
| Not Available |
| Full Name | Ezell Chiropractic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2201 1st Capitol Dr, Saint Charles, Missouri |
| Authorized Official Name and Position | Glenn R. Ezell (OWNER/DOCTOR) |
| Authorized Official Contact | 6369160660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ezell Chiropractic Llc 2201 1st Capitol Dr Saint Charles MO 63301-5805 Ph: (636) 916-0660 | Ezell Chiropractic Llc 2201 1st Capitol Dr Saint Charles MO 63301-5805 Ph: (636) 916-0660 |
| NPI Number | 1982035440 |
|---|---|
| Provider Enumeration Date | 12/10/2013 |
| Last Update Date | 09/14/2022 |
| Medicare PECOS PAC ID | 7416187810 |
|---|---|
| Medicare Enrollment ID | O20140305000080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982035440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2013000467 (Missouri) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 2013000467 (Missouri) | Primary |
| Provider Name | Glenn Robert Ezell |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1942547062 PECOS PAC ID: 8325278724 Enrollment ID: I20140305000119 |
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