Provider Demographics
NPI:1386826089
Name:SELLERS FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SELLERS FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-468-8884
Mailing Address - Street 1:405 WAL MART DRIVE
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080
Mailing Address - Country:US
Mailing Address - Phone:573-468-8884
Mailing Address - Fax:573-468-8886
Practice Address - Street 1:405 WAL MART DRIVE
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080
Practice Address - Country:US
Practice Address - Phone:573-468-8884
Practice Address - Fax:573-468-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033261649OtherPROVIDER NPI
MOU74806Medicare UPIN