INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER O (NPI# 1306203096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306203096 |
Entity Type | Organization |
Organization Name | INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER O |
Other Organization Name | IMAC REGENERATION CENTER OF ST. LOUIS |
Practice Address |
13353 Olive Blvd Chesterfield MO 63017-3108 |
Mailing Address |
2725 James Sanders Blvd Suite A Paducah KY 42001-8401 |
Practice Telephone | 3142004955 |
Practice Fax Number | 3146826001 |
Mailing Telephone | 3142004955 |
Enumeration Date | 2016-01-26 |
Last Update Date | 2020-08-19 |
Authorized Official Name | THERESA LUECKE (HUMAN RESOURCES) |
Authorized Official Telephone | 2705545114 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 111N00000X | Chiropractor | Chiropractic Providers | ||
N | 111NX0800X |
Chiropractor Specialization: Orthopedic |
Chiropractic Providers | ||
N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 225700000X | Massage Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 227800000X | Respiratory Therapist, Certified | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
N | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
IMAC Regeneration Center of St. Louis | Other Name - Individual/Organization |
Address | Telephone Number | Fax Number |
---|---|---|
263 Salt Lick Rd, Saint Peters, MO 633765974 | 3142004955 | 3146826001 |
Street Address |
13353 OLIVE BLVD |
City | CHESTERFIELD |
State | MO |
Zip Code | 63017-3108 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770568727 | Douglas Allen Bouldin | Nurse Practitioner | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2005-12-13 |
1720538317 | Julie Stutko | Nurse Practitioner | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2016-10-07 |
1285181487 | Hillary Dawn Gibson | Physical Therapist | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2016-09-06 |
1619372349 | Cynthia Davis | Chiropractor | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2014-10-23 |
1912299280 | Lance R Hatch | Chiropractor | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2011-05-05 |
1467756833 | Ronald Leigh Patrick | Chiropractor | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2010-12-29 |
1750608469 | Eric Siegal | Chiropractor | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2010-04-21 |
1578573549 | Sandra Miller | Physical Therapist | 13353 Olive Blvd, Chesterfield, MO 63017-3108 | 2006-08-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114549193 | Kathryn E Bos | Student in an Organized Health Care Education/Training Program | 873 Apt N Foxsprings Dr, Chesterfield, MO 63017 | 2020-05-12 |
1700415171 | Charles H. Edwards | Physical Therapist | 224 South Woods Millrd., Suite 610 South, Chesterfield, MO 63017 | 2020-04-07 |
1003454562 | Stephanie Henningsen | Physical Therapy Assistant | 307 S Woods Rd, Chesterfield, MO 63017 | 2019-12-16 |
1831746296 | Star Lynn Sutton | Occupational Therapy Assistant | 15207 Olive Boulevard, Chesterfield, MO 63017 | 2019-08-21 |
1639738438 | Van Amburg & Busiek Md's, LLC | Pharmacy | 232 S Woodsmill Road, Suite 330 East, Chesterfield, MO 63017 | 2019-06-06 |
1306306865 | Margaret Mary Wynn | Nurse Practitioner | 15740 South Outer Road, Chesterfield, MO 63017 | 2019-03-21 |
1205393089 | Kimberly Danielle | Nurse Practitioner | 744 Forest Trace Dr, Chesterfield, MO 63017 | 2019-02-27 |
1457823965 | Allison Joy Mcgrail | Dietitian, Registered | 45740 S Outer Forty Rd, Chesterfield, MO 63017 | 2018-12-21 |
1316418080 | Julie Lefere | Social Worker | Mercy Virtual Care Center, 15740 S Outer 40 Rd, Chesterfield, MO 63017 | 2018-12-06 |
1336629641 | Catherine Dolphin Smith | Nurse Practitioner | 224 S Woods Mill Rd Ste 500, Chesterfield, MO 63017 | 2018-08-16 |
Find all providers in zip 63017 |
Taxonomy Code | 207QS0010X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Sports Medicine |
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639645070 | Bluetail Biologics LLC | Family Medicine | 17300 N Outer 40 Rd Ste 201, Chesterfield, MO 63005-1364 | 2018-10-23 |
1922116763 | Kristin Suzanne Oliver | Family Medicine | 17300 North Outer 40 Rd Ste 201, Chesterfield, MO 63005-1364 | 2006-08-29 |
1295968311 | Adam P Pasternak | Family Medicine | 17701 Edison Ave, Ste. 101, Chesterfield, MO 63005-1266 | 2009-08-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871105312 | 417 Sports Medicine and Orthopedics LLC | Family Medicine | 330 W Plainview Rd Ste F, Springfield, MO 65810-2672 | 2020-08-17 |
1871115857 | Ben Heimos | Family Medicine | 1 S Compton Ave, Saint Louis, MO 63103-2001 | 2020-05-12 |
1083096671 | Daniel O'loughlin | Family Medicine | 1605 Martin Springs Dr Ste 330, Rolla, MO 65401-2980 | 2015-06-19 |
1295175057 | Devin Willis | Family Medicine | 16555 Manchester Rd Ste 100, Wildwood, MO 63040 | 2013-06-26 |
1922377274 | Duocorp Enterprises, LLC | Family Medicine | 1525 E Republic Rd, Suite A115, Springfield, MO 65804-6527 | 2011-12-15 |
1689960171 | Nathan Lee Granneman | Family Medicine | 200 Corporate Lake Dr, Columbia, MO 65203-7172 | 2011-06-22 |
1063568640 | Christian Verry | Family Medicine | 12680 Olive Blvd Ste 300, Saint Louis, MO 63141-6322 | 2007-01-26 |
1942238027 | John J Dougherty | Family Medicine | 1010 Carondelet Dr Ste 220, Kansas City, MO 64114-4822 | 2006-06-29 |
1548867963 | Elizabeth Savika Liotta | Family Medicine | 916 Olive St, Saint Louis, MO 63101-1400 | 2020-10-08 |
1750872354 | Iconic Services Inc | Family Medicine | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108-3729 | 2018-05-21 |
Find all providers with the same taxonomy |
City | CHESTERFIELD |
Zip Code | 63017 |
Please comment or provide details below to improve the information on INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER O.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.