Provider Demographics
NPI:1316192172
Name:NIXAS MAIN STREET CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NIXAS MAIN STREET CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:B,SC,DC
Authorized Official - Phone:417-724-9994
Mailing Address - Street 1:106 W SHERMAN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7620
Mailing Address - Country:US
Mailing Address - Phone:417-724-9994
Mailing Address - Fax:417-724-9965
Practice Address - Street 1:106 W SHERMAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7620
Practice Address - Country:US
Practice Address - Phone:417-724-9994
Practice Address - Fax:417-724-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty