Provider Demographics
NPI:1609058114
Name:NORTHEAST FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTHEAST FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-376-9355
Mailing Address - Street 1:225 W HAYDEN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARCELINE
Mailing Address - State:MO
Mailing Address - Zip Code:64658-1049
Mailing Address - Country:US
Mailing Address - Phone:660-376-9355
Mailing Address - Fax:660-376-3733
Practice Address - Street 1:225 W HAYDEN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MARCELINE
Practice Address - State:MO
Practice Address - Zip Code:64658-1049
Practice Address - Country:US
Practice Address - Phone:660-376-9355
Practice Address - Fax:660-376-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU99321Medicare UPIN