Provider Demographics
NPI:1427597632
Name:CHIROPRACTIC AND SPINAL REHAB LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC AND SPINAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-364-2798
Mailing Address - Street 1:806A E STATE ROUTE 72
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3945
Mailing Address - Country:US
Mailing Address - Phone:573-364-2798
Mailing Address - Fax:573-368-4720
Practice Address - Street 1:806A E STATE ROUTE 72
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3945
Practice Address - Country:US
Practice Address - Phone:573-364-2798
Practice Address - Fax:573-368-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6455111N00000X
MO2017003593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000031453Medicare UPIN