Integrated Medicine and Chiropractic Regeneration Center O

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER O

Practice address

13353 Olive Blvd
Chesterfield, MO 63017-3108

Phone

(314) 200-4955

Fax

(314) 682-6001

NPI assigned

Jan 26, 2016

Organization subpart

No

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

Authorized official

Name

Theresa Luecke

Title

Human Resources

Phone

(270) 554-5114

Specialties & licenses 14

Addresses

Other names 1

• IMAC Regeneration Center of St. Louis Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sara Anne M Davidson, DPT

  • Physical Therapist
  • Brentwood, TN
  • NPI 1437539293
  NPD (past)

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

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1306203096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 JAMES SANDERS BLVD",
            "address_2": "SUITE A",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420018401",
            "telephone_number": "314-200-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13353 OLIVE BLVD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173108",
            "telephone_number": "314-200-4955",
            "fax_number": "314-682-6001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "263 Salt Lick Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633765974",
            "country_code": "US",
            "telephone_number": "314-200-4955",
            "fax_number": "314-682-6001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER O",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-26",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "LUECKE",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "270-554-5114"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "227800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Respiratory Therapist, Certified",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMAC Regeneration Center of St. Louis",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "IMAC Regeneration Center of St. Louis",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Sports Medicine (Family Medicine) Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Sports Medicine (Family Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.