Provider Demographics
NPI:1366697195
Name:DELTA SPINAL REHAB P.C.
Entity type:Organization
Organization Name:DELTA SPINAL REHAB P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MAFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-725-3358
Mailing Address - Street 1:11720 OLD BALLAS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7028
Mailing Address - Country:US
Mailing Address - Phone:314-725-3358
Mailing Address - Fax:
Practice Address - Street 1:11720 OLD BALLAS RD STE 2
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7028
Practice Address - Country:US
Practice Address - Phone:314-725-3358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021787111N00000X
MO2001032183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty