Provider Demographics
NPI:1801464763
Name:CHIROPRO OF EUREKA, LLC
Entity type:Organization
Organization Name:CHIROPRO OF EUREKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-979-0398
Mailing Address - Street 1:409 MERAMEC BLVD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3906
Mailing Address - Country:US
Mailing Address - Phone:618-979-0398
Mailing Address - Fax:314-530-2457
Practice Address - Street 1:409 MERAMEC BLVD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3906
Practice Address - Country:US
Practice Address - Phone:618-979-0398
Practice Address - Fax:314-530-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty