Provider Demographics
NPI:1376041665
Name:ELITE CHIROPRACTIC OF THE OZARKS, LLC
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC OF THE OZARKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-274-4366
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:BRANDSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65688-0485
Mailing Address - Country:US
Mailing Address - Phone:417-257-2477
Mailing Address - Fax:
Practice Address - Street 1:240 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2726
Practice Address - Country:US
Practice Address - Phone:417-257-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018000970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty