Provider Demographics
NPI:1932523131
Name:SWEENEY WELLNESS LLC
Entity Type:Organization
Organization Name:SWEENEY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-651-5705
Mailing Address - Street 1:902 PALM BAY DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7936
Mailing Address - Country:US
Mailing Address - Phone:314-651-5705
Mailing Address - Fax:
Practice Address - Street 1:8005 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-3518
Practice Address - Country:US
Practice Address - Phone:314-353-4500
Practice Address - Fax:314-353-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty