Provider Demographics
NPI:1275992075
Name:TOTAL ALIGNMENT CHIROPRACTIC
Entity Type:Organization
Organization Name:TOTAL ALIGNMENT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-776-7246
Mailing Address - Street 1:2725 N WESTWOOD BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2367
Mailing Address - Country:US
Mailing Address - Phone:573-776-7246
Mailing Address - Fax:844-270-7119
Practice Address - Street 1:2725 N WESTWOOD BLVD STE 13
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2367
Practice Address - Country:US
Practice Address - Phone:573-776-7246
Practice Address - Fax:844-270-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016002123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty