Provider Demographics
NPI:1952025082
Name:AYH-MARYVILLE, LLC
Entity Type:Organization
Organization Name:AYH-MARYVILLE, LLC
Other - Org Name:ACTIVATE YOUR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-676-9100
Mailing Address - Street 1:707 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2975
Mailing Address - Country:US
Mailing Address - Phone:816-676-9100
Mailing Address - Fax:
Practice Address - Street 1:918 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2635
Practice Address - Country:US
Practice Address - Phone:660-224-0884
Practice Address - Fax:660-224-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty