1427597632 NPI number — CHIROPRACTIC AND SPINAL REHAB LLC

Table of content: (NPI 1427597632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427597632 NPI number — CHIROPRACTIC AND SPINAL REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC AND SPINAL REHAB LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427597632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806A E STATE ROUTE 72
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROLLA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65401-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-364-2798
Provider Business Mailing Address Fax Number:
573-368-4720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806A E STATE ROUTE 72
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROLLA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65401-3945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-364-2798
Provider Business Practice Location Address Fax Number:
573-368-4720
Provider Enumeration Date:
02/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HEITMAN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-364-2798

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6455 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 2017003593 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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