Provider Demographics
NPI:1851919203
Name:RESILIENT CLINIC LLC
Entity Type:Organization
Organization Name:RESILIENT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-535-1912
Mailing Address - Street 1:21450 HIGHWAY 32 STE A
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-8814
Mailing Address - Country:US
Mailing Address - Phone:573-535-1912
Mailing Address - Fax:
Practice Address - Street 1:21450 HIGHWAY 32 STE A
Practice Address - Street 2:
Practice Address - City:SAINTE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-8814
Practice Address - Country:US
Practice Address - Phone:573-535-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty