Provider Demographics
NPI:1356090096
Name:CARROLLTON CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:CARROLLTON CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-542-2441
Mailing Address - Street 1:1300 N US HIGHWAY 65 STE A&B
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-1975
Mailing Address - Country:US
Mailing Address - Phone:660-542-2441
Mailing Address - Fax:660-542-2442
Practice Address - Street 1:1300 N US HIGHWAY 65 STE A&B
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1975
Practice Address - Country:US
Practice Address - Phone:660-542-2441
Practice Address - Fax:660-542-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty