Provider Demographics
NPI:1245587864
Name:BRASSIE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BRASSIE CHIROPRACTIC LLC
Other - Org Name:JOEL A BRASSIE, D.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BRASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-394-4101
Mailing Address - Street 1:972 KEHRS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2402
Mailing Address - Country:US
Mailing Address - Phone:636-394-4101
Mailing Address - Fax:636-394-3022
Practice Address - Street 1:972 KEHRS MILL RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2402
Practice Address - Country:US
Practice Address - Phone:636-394-4101
Practice Address - Fax:636-394-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004030216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV05931Medicare UPIN