Provider Demographics
NPI:1912577461
Name:PECULIAR FAMILY CHIROPRACTIC & SPORTS MEDICINE,
Entity Type:Organization
Organization Name:PECULIAR FAMILY CHIROPRACTIC & SPORTS MEDICINE,
Other - Org Name:PARSONS CHIROPRACTIC AND SP ME CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-602-2866
Mailing Address - Street 1:201 S STATE ROUTE C
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9729
Mailing Address - Country:US
Mailing Address - Phone:816-779-1022
Mailing Address - Fax:
Practice Address - Street 1:201 S STATE ROUTE C
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9729
Practice Address - Country:US
Practice Address - Phone:816-779-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912577461OtherTYPE 2 ORGANIZATION NPI