Provider Demographics
NPI:1497054324
Name:RESTORATION HEALTH SERVICE
Entity Type:Organization
Organization Name:RESTORATION HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVIN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-254-4624
Mailing Address - Street 1:100 S STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:64054-1215
Mailing Address - Country:US
Mailing Address - Phone:816-254-4624
Mailing Address - Fax:816-254-4624
Practice Address - Street 1:100 S STERLING AVE
Practice Address - Street 2:
Practice Address - City:SUGAR CREEK
Practice Address - State:MO
Practice Address - Zip Code:64054-1215
Practice Address - Country:US
Practice Address - Phone:816-254-4624
Practice Address - Fax:816-254-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty