Provider Demographics
NPI:1164579553
Name:PIKE CHIROPRACTIC
Entity Type:Organization
Organization Name:PIKE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-348-4640
Mailing Address - Street 1:4075 OSAGE BEACH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-2153
Mailing Address - Country:US
Mailing Address - Phone:573-348-4640
Mailing Address - Fax:573-348-4660
Practice Address - Street 1:4075 OSAGE BEACH PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-348-4640
Practice Address - Fax:573-348-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005651111N00000X
MO005653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031295Medicare PIN