Provider Demographics
NPI:1124899497
Name:CLEOUS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CLEOUS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DC
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLEOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-880-1959
Mailing Address - Street 1:3098 JACOB AVE
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8986
Mailing Address - Country:US
Mailing Address - Phone:417-880-1959
Mailing Address - Fax:
Practice Address - Street 1:400 S 11TH ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5508
Practice Address - Country:US
Practice Address - Phone:573-785-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty