Provider Demographics
NPI:1710400593
Name:GRAIN VALLEY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GRAIN VALLEY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-443-5485
Mailing Address - Street 1:203 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-9703
Mailing Address - Country:US
Mailing Address - Phone:816-443-5485
Mailing Address - Fax:816-443-5652
Practice Address - Street 1:203 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-9703
Practice Address - Country:US
Practice Address - Phone:816-443-5485
Practice Address - Fax:816-443-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty