Trenton Parker Civello, DC
Individual provider Active NPI Chiropractor · Frontenac, MO
NPI 1497319628 · NPPES record last updated Jan 6, 2022
Key facts
- NPI
- 1497319628
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2018022370 (MO)
- Practice address
- 2051 S Lindbergh
Frontenac, MO 63131 - Phone
- (148) 880-8583
- NPI assigned
- Apr 23, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Life Clinic of Mo DC PC
Practice addresses (Care Compare)
2051 S Lindbergh Blvd
Frontenac, MO 63131-3504
Phone (314) 888-0858
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201201003190 | MO | Practitioner - Chiropractic | 3779994447 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018022370 | MO | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Clinic of Mo DC PC | Chiropractor | Current |
Accepting new patients |
Locations
2051 S Lindbergh Blvd
Frontenac, MO 63131
Phone (314) 888-0858
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2018022370 | MO | Yes |
Addresses
Primary practice location
2051 S Lindbergh
Frontenac, MO 63131
Mailing address
2051 S Lindbergh
Frontenac, MO 63131
Phone (314) 888-0858
Other providers in Frontenac, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.