Provider Demographics
NPI:1033586847
Name:ARBAVADA CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ARBAVADA CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:ARBAVADA CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-603-7301
Mailing Address - Street 1:1552 NATCHEZ DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2353
Mailing Address - Country:US
Mailing Address - Phone:636-937-7771
Mailing Address - Fax:636-937-7775
Practice Address - Street 1:1552 NATCHEZ DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2353
Practice Address - Country:US
Practice Address - Phone:636-937-7771
Practice Address - Fax:636-937-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014010611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty