Provider Demographics
NPI:1427544188
Name:ADVANCED CHIROPRACTIC OF NODAWAY COUNTY, P.C.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF NODAWAY COUNTY, P.C.
Other - Org Name:ADVANCED CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-582-5959
Mailing Address - Street 1:1206 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2604
Mailing Address - Country:US
Mailing Address - Phone:660-582-5959
Mailing Address - Fax:660-582-6373
Practice Address - Street 1:1206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2604
Practice Address - Country:US
Practice Address - Phone:660-582-5959
Practice Address - Fax:660-582-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016042714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty