Provider Demographics
NPI:1669015228
Name:CHIROPRO OF COLUMBIA, LLC
Entity Type:Organization
Organization Name:CHIROPRO OF COLUMBIA, LLC
Other - Org Name:CHIROPRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-719-2350
Mailing Address - Street 1:1005 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236
Mailing Address - Country:US
Mailing Address - Phone:618-979-0398
Mailing Address - Fax:314-530-2457
Practice Address - Street 1:1005 SOUTH MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236
Practice Address - Country:US
Practice Address - Phone:618-719-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty