NPIMap

Organization Active NPI

Aequa Health and Wellness LLC

  • Chiropractor
  • Ellisville, MO
National Provider Identifier
1235543158
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2009030088 Issued in MO
Legal business name
AEQUA HEALTH AND WELLNESS LLC
Practice address
179 Clarkson Executive Park
Ellisville, MO 63011-2176
Phone
(636) 227-4442
NPI assigned
Jun 18, 2014
Last updated
Jun 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Michael Fazio, DC
Title
Owner
Phone
(636) 227-4442

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 2009030088 MO Primary

Addresses

Primary practice location

179 Clarkson Executive Park
Ellisville, MO 63011-2176

Mailing address

179 Clarkson Executive Park
Ellisville, MO 63011-2176
Phone (636) 227-4442

National Provider Directory

National Provider Directory

Locations

179 Clarkson Executive Park
Ellisville, MO 63011
Phone (314) 452-4972

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1235543158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 CLARKSON EXECUTIVE PARK",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112176",
            "telephone_number": "636-227-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 CLARKSON EXECUTIVE PARK",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112176",
            "telephone_number": "636-227-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEQUA HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "FAZIO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-227-4442",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2009030088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.