Provider Demographics
NPI:1164129268
Name:KC CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KC CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-406-1342
Mailing Address - Street 1:222 W HUNTERS RDG
Mailing Address - Street 2:
Mailing Address - City:VALMEYER
Mailing Address - State:IL
Mailing Address - Zip Code:62295-3019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 E MILL ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1519
Practice Address - Country:US
Practice Address - Phone:618-406-1342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty