Provider Demographics
NPI:1760415988
Name:OROURKE WELLNESS CENTER PC
Entity Type:Organization
Organization Name:OROURKE WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:OROURKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:660-663-2101
Mailing Address - Street 1:122 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-1156
Mailing Address - Country:US
Mailing Address - Phone:660-663-2101
Mailing Address - Fax:660-663-2150
Practice Address - Street 1:122 N MARKET ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-1156
Practice Address - Country:US
Practice Address - Phone:660-663-2101
Practice Address - Fax:660-663-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT620000Medicare ID - Type Unspecified