Provider Demographics
NPI:1548273725
Name:RIVERTOWNE FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:RIVERTOWNE FAMILY CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BICKMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-947-7463
Mailing Address - Street 1:1362 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2444
Mailing Address - Country:US
Mailing Address - Phone:636-947-7463
Mailing Address - Fax:636-947-7177
Practice Address - Street 1:1362 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2444
Practice Address - Country:US
Practice Address - Phone:636-947-7463
Practice Address - Fax:636-947-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4668026OtherAETNA PIN - DR. BICKMEYER
MO4728OtherANTHEM ID - DR. BICKMEYER
MO7986711OtherAETNA PIN - DR. LOCK
MO205255OtherDR. LOCK ANTHEM ID
MOU40344Medicare UPIN