Provider Demographics
NPI:1649910803
Name:CHIROMART MISSOURI
Entity type:Organization
Organization Name:CHIROMART MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALTIST
Authorized Official - Prefix:
Authorized Official - First Name:BAILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-573-7145
Mailing Address - Street 1:1605 WESTGATE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 THF BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1123
Practice Address - Country:US
Practice Address - Phone:636-536-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty