Provider Demographics
NPI:1265098636
Name:TRUE ROOTS CHIROPRACTIC & WELLNESS PLLC
Entity type:Organization
Organization Name:TRUE ROOTS CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-891-4551
Mailing Address - Street 1:7012 KINGSMILL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7387
Mailing Address - Country:US
Mailing Address - Phone:217-679-3637
Mailing Address - Fax:
Practice Address - Street 1:7012 KINGSMILL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7387
Practice Address - Country:US
Practice Address - Phone:217-679-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty