1508986886 NPI number — MR. CHRISTIAN WOLLMERSHAUSER ATC,LAT,BS

Table of content: MR. CHRISTIAN WOLLMERSHAUSER ATC,LAT,BS (NPI 1508986886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508986886 NPI number — MR. CHRISTIAN WOLLMERSHAUSER ATC,LAT,BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLLMERSHAUSER
Provider First Name:
CHRISTIAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC,LAT,BS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508986886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 ENWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-4664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-928-9665
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 MEXICO RD
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-939-9540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  2006028777 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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