Provider Demographics
NPI:1093981441
Name:SUNRISE CHIROPRACTIC ACUPUNCTURE AND NUTRITION LLC
Entity Type:Organization
Organization Name:SUNRISE CHIROPRACTIC ACUPUNCTURE AND NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-224-3440
Mailing Address - Street 1:412 NW MOCK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2511
Mailing Address - Country:US
Mailing Address - Phone:816-224-3440
Mailing Address - Fax:
Practice Address - Street 1:412 NW MOCK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2511
Practice Address - Country:US
Practice Address - Phone:816-224-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty