Provider Demographics
NPI:1902233851
Name:CHIROPRACTIC WELLNESS CONNECTION OF WEBSTER GROVES PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CONNECTION OF WEBSTER GROVES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:COGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-471-5554
Mailing Address - Street 1:26421 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4528
Mailing Address - Country:US
Mailing Address - Phone:248-905-5066
Mailing Address - Fax:248-905-5069
Practice Address - Street 1:7501 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2103
Practice Address - Country:US
Practice Address - Phone:314-644-5333
Practice Address - Fax:314-961-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty