Provider Demographics
NPI:1619492931
Name:MISSION CHIROPRACTIC CO LLC
Entity Type:Organization
Organization Name:MISSION CHIROPRACTIC CO LLC
Other - Org Name:MISSION CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-559-8666
Mailing Address - Street 1:1580 KING AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2067
Mailing Address - Country:US
Mailing Address - Phone:614-559-8666
Mailing Address - Fax:
Practice Address - Street 1:1580 KING AVE STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2067
Practice Address - Country:US
Practice Address - Phone:614-559-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC04562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty