Back & Neck Care Center of Olivette, L.L.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2012000065 Issued in MO

Legal business name

BACK & NECK CARE CENTER OF OLIVETTE, L.L.C.

Practice address

9449 Olive Blvd
Olivette, MO 63132-3130

Phone

(314) 432-2220

Fax

(314) 432-8161

NPI assigned

Apr 1, 2016

Last updated

Apr 1, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Roesler, D.C.NPI 1801167192

Title

Owner

Phone

(314) 432-2220

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

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.

• Kyle Alderson Roesler, D.C.

  • Chiropractor
  • Olivette, MO
  • NPI 1801167192
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1275996704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9449 OLIVE BLVD",
            "city": "OLIVETTE",
            "state": "MO",
            "postal_code": "631323130",
            "telephone_number": "314-432-2220",
            "fax_number": "314-432-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9449 OLIVE BLVD",
            "city": "OLIVETTE",
            "state": "MO",
            "postal_code": "631323130",
            "telephone_number": "314-432-2220",
            "fax_number": "314-432-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK & NECK CARE CENTER OF OLIVETTE, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-01",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "ROESLER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-432-2220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2012000065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Olivette, MO
• Providers in Olivette, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.