Provider Demographics
NPI:1487205530
Name:CHIROPRACTIC FAMILY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC FAMILY WELLNESS CENTER LLC
Other - Org Name:CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-478-2117
Mailing Address - Street 1:1747 SMIZER STATION RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2784
Mailing Address - Country:US
Mailing Address - Phone:314-478-2117
Mailing Address - Fax:
Practice Address - Street 1:1747 SMIZER STATION RD STE 4
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2784
Practice Address - Country:US
Practice Address - Phone:636-825-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSET HILLS FAMILY CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821333824OtherCHIROPRACTOR