Provider Demographics
NPI:1558487603
Name:KLINGINSMITH CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:KLINGINSMITH CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLINGINSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:696-937-3207
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-0003
Mailing Address - Country:US
Mailing Address - Phone:636-937-3207
Mailing Address - Fax:636-937-5307
Practice Address - Street 1:105 BORGA BUILDING
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1136
Practice Address - Country:US
Practice Address - Phone:636-937-3207
Practice Address - Fax:636-937-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU87234Medicare UPIN