Provider Demographics
NPI:1952461170
Name:SURFSIDE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SURFSIDE CHIROPRACTIC INC.
Other - Org Name:SURFSIDE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-466-7166
Mailing Address - Street 1:731 HASTINGS ST.
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1020
Mailing Address - Country:US
Mailing Address - Phone:417-466-7166
Mailing Address - Fax:417-466-7591
Practice Address - Street 1:731 HASTINGS ST.
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1020
Practice Address - Country:US
Practice Address - Phone:417-466-7166
Practice Address - Fax:417-466-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty