Provider Demographics
NPI:1760571129
Name:PARADISE DEVELOPERS, LLC
Entity Type:Organization
Organization Name:PARADISE DEVELOPERS, LLC
Other - Org Name:THE WELLNESS CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-322-2644
Mailing Address - Street 1:207 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9729
Mailing Address - Country:US
Mailing Address - Phone:816-322-2644
Mailing Address - Fax:816-322-1440
Practice Address - Street 1:207 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9729
Practice Address - Country:US
Practice Address - Phone:816-322-2644
Practice Address - Fax:816-322-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L890000Medicare PIN