Provider Demographics
NPI:1386196103
Name:COLUMBIA CHIROPRACTIC GROUP LLC
Entity Type:Organization
Organization Name:COLUMBIA CHIROPRACTIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-397-5980
Mailing Address - Street 1:3302 W BROADWAY BUSINESS PARK CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0169
Mailing Address - Country:US
Mailing Address - Phone:573-397-5980
Mailing Address - Fax:583-234-4148
Practice Address - Street 1:3302 W BROADWAY BUSINESS PARK CT
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0169
Practice Address - Country:US
Practice Address - Phone:573-397-5980
Practice Address - Fax:583-234-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty