Provider Demographics
NPI:1265688279
Name:HERITAGE CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HERITAGE CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-228-8768
Mailing Address - Street 1:103 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9703
Mailing Address - Country:US
Mailing Address - Phone:816-322-1990
Mailing Address - Fax:816-322-0005
Practice Address - Street 1:103 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9703
Practice Address - Country:US
Practice Address - Phone:816-322-1990
Practice Address - Fax:816-322-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-09
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU85898Medicare UPIN