Provider Demographics
NPI:1609647981
Name:X CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:X CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:JUSTINE
Authorized Official - Last Name:EXELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-624-9538
Mailing Address - Street 1:33 SPANGLE WAY DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5525
Mailing Address - Country:US
Mailing Address - Phone:714-624-9538
Mailing Address - Fax:
Practice Address - Street 1:1023 MAIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1170
Practice Address - Country:US
Practice Address - Phone:636-639-8944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty