Provider Demographics
NPI:1932739471
Name:JAMES RIVER CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:JAMES RIVER CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANAFIN VICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-350-1131
Mailing Address - Street 1:5335 S CAMPBELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2492
Mailing Address - Country:US
Mailing Address - Phone:417-350-1131
Mailing Address - Fax:417-350-1191
Practice Address - Street 1:5335 S CAMPBELL AVE STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2492
Practice Address - Country:US
Practice Address - Phone:417-350-1131
Practice Address - Fax:417-350-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty