Provider Demographics
NPI:1538306642
Name:CLARKSVILLE CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:CLARKSVILLE CHIROPRACTIC CENTER, PC
Other - Org Name:CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GEARING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-754-5005
Mailing Address - Street 1:122 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISIANA
Mailing Address - State:MO
Mailing Address - Zip Code:63353-2060
Mailing Address - Country:US
Mailing Address - Phone:573-754-5005
Mailing Address - Fax:
Practice Address - Street 1:122 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-2060
Practice Address - Country:US
Practice Address - Phone:573-754-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022068101YP2500X
MO006761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1083704852OtherNPI
1972587574OtherNPI