Provider Demographics
NPI:1679610299
Name:GAUTHIER CHIROPRACTIC CLINIC, P. C.
Entity Type:Organization
Organization Name:GAUTHIER CHIROPRACTIC CLINIC, P. C.
Other - Org Name:GAUTHIER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE-LAURE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-741-9232
Mailing Address - Street 1:6008 N STATE ROUTE 9
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3549
Mailing Address - Country:US
Mailing Address - Phone:816-741-9232
Mailing Address - Fax:816-741-3118
Practice Address - Street 1:6008 N STATE ROUTE 9
Practice Address - Street 2:SUITE A
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3549
Practice Address - Country:US
Practice Address - Phone:816-741-9232
Practice Address - Fax:816-741-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MON750000Medicare ID - Type Unspecified