Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 2012033594 | MO |
NPI | 1659622157 |
---|---|
Provider Name | Dr. Autumn Rebecca Barton |
First Address | Saint Louis, MO 63127-1831 |
Second Address | Saint Louis, MO 63127-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 24/09/2012 |