Provider Demographics
NPI:1982072104
Name:THRIVE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:THRIVE CHIROPRACTIC, LLC
Other - Org Name:TRI LAKES CHIROSPORT, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ST. ONGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-598-0080
Mailing Address - Street 1:574 HIGHWAY 248 STE 4
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7733
Mailing Address - Country:US
Mailing Address - Phone:417-598-0080
Mailing Address - Fax:
Practice Address - Street 1:574 HIGHWAY 248 STE 4
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7733
Practice Address - Country:US
Practice Address - Phone:417-598-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty