NPIMap

Organization Active NPI

Fit 4 Life Sports and Rehabilitation, L.L.C.

  • Chiropractor
  • O Fallon, MO
National Provider Identifier
1619378932
Registry record updated Sep 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2002030437 Issued in MO
Legal business name
FIT 4 LIFE SPORTS AND REHABILITATION, L.L.C.
Practice address
210 Triad Ctr W
O Fallon, MO 63366-7543
Phone
(636) 542-4044
Fax
(636) 489-1154
NPI assigned
Sep 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2014

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

Authorized official

Name
Connie Sue Hayes, D.C.NPI 1649588898
Title
President/Owner
Phone
(636) 542-4044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2002030437 MO Primary

Addresses

Primary practice location

210 Triad Ctr W
O Fallon, MO 63366-7543

Mailing address

210 Triad Ctr W
O Fallon, MO 63366-7543
Phone (636) 542-4044

National Provider Directory

National Provider Directory

Locations

210 Triad Ctr W
O Fallon, MO 63366
Phone (314) 302-0542

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409875200000",
    "number": "1619378932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 TRIAD CTR W",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633667543",
            "telephone_number": "636-542-4044",
            "fax_number": "636-489-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 TRIAD CTR W",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633667543",
            "telephone_number": "636-542-4044",
            "fax_number": "636-489-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIT 4 LIFE SPORTS AND REHABILITATION, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-05",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "636-542-4044",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2002030437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.