Provider Demographics
NPI:1811177967
Name:SIRAGUSO CHIROPRACTIC INC.
Entity type:Organization
Organization Name:SIRAGUSO CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SIRAGUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-415-2900
Mailing Address - Street 1:113 BLUE JAY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1997
Mailing Address - Country:US
Mailing Address - Phone:816-415-2900
Mailing Address - Fax:816-415-2903
Practice Address - Street 1:113 BLUE JAY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1997
Practice Address - Country:US
Practice Address - Phone:816-415-2900
Practice Address - Fax:816-415-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006282111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty