Provider Demographics
NPI:1346808003
Name:SIMPLY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SIMPLY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GUISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-693-5091
Mailing Address - Street 1:696 W MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9604
Mailing Address - Country:US
Mailing Address - Phone:417-693-5091
Mailing Address - Fax:
Practice Address - Street 1:696 W MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9604
Practice Address - Country:US
Practice Address - Phone:417-693-5091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty