Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2013001703 | MO |
N | 111NN1001X | Nutrition | 2013001703 | MO |
N | 111NR0400X | Rehabilitation Chiropractor | 2013001703 | MO |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2013001703 | MO |
NPI | 1437491636 |
---|---|
Provider Name | Dr. Justin Michael Hoffman |
First Address | Saint Peters, MO 63376-1593 |
Second Address | Saint Peters, MO 63376-1593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 06/05/2013 |