Provider Demographics
NPI:1326130345
Name:ALLIED PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:ALLIED PHYSICIANS GROUP LLC
Other - Org Name:BREAKTHROUGH PAIN RELIEF CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-391-1800
Mailing Address - Street 1:14324 SOUTH OUTER 40 ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWN & COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-0000
Mailing Address - Country:US
Mailing Address - Phone:314-909-8778
Mailing Address - Fax:314-909-8777
Practice Address - Street 1:14324 SOUTH OUTER 40 ROAD
Practice Address - Street 2:
Practice Address - City:TOWN & COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-0000
Practice Address - Country:US
Practice Address - Phone:314-909-8778
Practice Address - Fax:314-909-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty