Provider Demographics
NPI:1114109535
Name:REFLEX CHIROPRACTIC & ACUPUNCTURE, PC
Entity Type:Organization
Organization Name:REFLEX CHIROPRACTIC & ACUPUNCTURE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STORM
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-877-9404
Mailing Address - Street 1:1730 E REPUBLIC RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6549
Mailing Address - Country:US
Mailing Address - Phone:417-877-9404
Mailing Address - Fax:417-877-9408
Practice Address - Street 1:1730 E REPUBLIC RD
Practice Address - Street 2:SUITE I
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6549
Practice Address - Country:US
Practice Address - Phone:417-877-9404
Practice Address - Fax:417-877-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty