Provider Demographics
NPI:1184871501
Name:PECAUT CHIROPRACTIC PC
Entity type:Organization
Organization Name:PECAUT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:PECAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-647-8811
Mailing Address - Street 1:3123 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2303
Mailing Address - Country:US
Mailing Address - Phone:314-647-8811
Mailing Address - Fax:
Practice Address - Street 1:3123 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2303
Practice Address - Country:US
Practice Address - Phone:314-647-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty