Provider Demographics
NPI:1366634818
Name:MARYVILLE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:MARYVILLE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-582-8511
Mailing Address - Street 1:1626 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-3104
Mailing Address - Country:US
Mailing Address - Phone:660-582-8511
Mailing Address - Fax:660-582-8511
Practice Address - Street 1:1626 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3104
Practice Address - Country:US
Practice Address - Phone:660-582-8511
Practice Address - Fax:660-582-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO82760OtherCOVENTRY
MO1730298639OtherCOMMUNITY HEALTH PLAN
MO670535OtherUNITED HEALTH CARE