Provider Demographics
NPI:1467625392
Name:FOUR RIVERS CHIROPRACTIC AND ACUPUNCTURE LLC
Entity type:Organization
Organization Name:FOUR RIVERS CHIROPRACTIC AND ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-239-1220
Mailing Address - Street 1:707 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-2709
Mailing Address - Country:US
Mailing Address - Phone:636-239-1220
Mailing Address - Fax:636-239-0331
Practice Address - Street 1:707 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2709
Practice Address - Country:US
Practice Address - Phone:636-239-1220
Practice Address - Fax:636-239-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008001508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty