Provider Demographics
NPI:1639438260
Name:HEALTHY HEALING CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEALTHY HEALING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-489-1616
Mailing Address - Street 1:16925 MANCHESTER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1219
Mailing Address - Country:US
Mailing Address - Phone:636-489-1616
Mailing Address - Fax:
Practice Address - Street 1:16925 MANCHESTER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1219
Practice Address - Country:US
Practice Address - Phone:636-489-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013553305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service