Provider Demographics
NPI:1518294552
Name:DYNAMIC CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ZINDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-492-6065
Mailing Address - Street 1:211 W HIGHWAY 19
Mailing Address - Street 2:PO BOX 148
Mailing Address - City:MARTINSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65264-2013
Mailing Address - Country:US
Mailing Address - Phone:573-492-6065
Mailing Address - Fax:573-492-6065
Practice Address - Street 1:211 W HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:MO
Practice Address - Zip Code:65264-2013
Practice Address - Country:US
Practice Address - Phone:573-492-6065
Practice Address - Fax:573-492-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty