Brentwood Spine Clinic LLC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

2010031861 Issued in MO

Legal business name

BRENTWOOD SPINE CLINIC LLC

Practice address

2202 S Brentwood Blvd
Brentwood, MO 63144-1804

Phone

(314) 600-6677

NPI assigned

Nov 24, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Clinton Joseph Daniels, D.C.NPI 1194033084

Title

Chiropractic Physician

Phone

(314) 600-6677

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Clinton J Daniels, D.C.

  • Chiropractor
  • Saint Louis, MO
  • NPI 1194033084
  NPD Authorized official

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

{
    "created_epoch": "1353715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1669716031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 S BRENTWOOD BLVD",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "631441804",
            "telephone_number": "314-600-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 S BRENTWOOD BLVD",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "631441804",
            "telephone_number": "314-600-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD SPINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-24",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIROPRACTIC PHYSICIAN",
        "authorized_official_telephone_number": "314-600-6677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "MO",
            "license": "2010031861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kathleen Bossung
• Brad McMillin, Inc
• Margaret E Braida, DPT
• Amy S Bredel
• Brentwood Adult Daycare
• Kenneth Neal Brosh, DDS
• Krista Danielle Brown
• Jennifer Rae Bruner, MA, ATR-BC, NCC
• Mitchell Ray Buerck
• Eve Bufalo

• Sports Physician Chiropractor in Brentwood, MO
• Providers in Brentwood, MO by specialty
• Sports Physician Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.