Provider Demographics
NPI:1568160364
Name:PECULIAR CHIROPRACTIC AND SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:PECULIAR CHIROPRACTIC AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-678-8178
Mailing Address - Street 1:201 S STATE ROUTE C
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9729
Mailing Address - Country:US
Mailing Address - Phone:816-779-1022
Mailing Address - Fax:
Practice Address - Street 1:201 S STATE ROUTE C
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9729
Practice Address - Country:US
Practice Address - Phone:816-779-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO230112566Medicaid