Provider Demographics
NPI:1831468925
Name:FIX CHIROPRACTIC AND NUTRITION CENTRE LLC
Entity type:Organization
Organization Name:FIX CHIROPRACTIC AND NUTRITION CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-778-1199
Mailing Address - Street 1:1908 GREENWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2430
Mailing Address - Country:US
Mailing Address - Phone:573-778-1199
Mailing Address - Fax:573-712-2799
Practice Address - Street 1:1908 GREENWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2430
Practice Address - Country:US
Practice Address - Phone:573-778-1199
Practice Address - Fax:573-712-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011037826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty