Provider Demographics
NPI:1619569365
Name:PAIGE DUENKE, D.C., LLC
Entity Type:Organization
Organization Name:PAIGE DUENKE, D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUENKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-721-5815
Mailing Address - Street 1:309 N GRAND ST
Mailing Address - Street 2:
Mailing Address - City:LADDONIA
Mailing Address - State:MO
Mailing Address - Zip Code:63352-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3618 S CLARK ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-4104
Practice Address - Country:US
Practice Address - Phone:573-721-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty