Provider Demographics
NPI:1821108143
Name:OFALLON CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:OFALLON CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-272-4625
Mailing Address - Street 1:110 E PITMAN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2619
Mailing Address - Country:US
Mailing Address - Phone:636-272-4625
Mailing Address - Fax:636-240-3522
Practice Address - Street 1:110 E PITMAN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2619
Practice Address - Country:US
Practice Address - Phone:636-272-4625
Practice Address - Fax:636-240-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE05026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty