Provider Demographics
NPI:1174047005
Name:MIDWEST SPINE & INJURY CENTERS, INC.
Entity type:Organization
Organization Name:MIDWEST SPINE & INJURY CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-567-7300
Mailing Address - Street 1:2108 SCHUETZ RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3538
Mailing Address - Country:US
Mailing Address - Phone:314-567-7300
Mailing Address - Fax:314-997-4326
Practice Address - Street 1:2108 SCHUETZ ROAD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-567-7300
Practice Address - Fax:314-997-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty