Provider Demographics
NPI:1376849398
Name:CHIROPRACTIC HEALING & RESTORATION LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALING & RESTORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-232-9437
Mailing Address - Street 1:1512 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2668
Mailing Address - Country:US
Mailing Address - Phone:816-232-9437
Mailing Address - Fax:
Practice Address - Street 1:1512 S 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2668
Practice Address - Country:US
Practice Address - Phone:816-232-9437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty