Provider Demographics
NPI:1154755585
Name:RUSTICI WELLNESS CENTER
Entity type:Organization
Organization Name:RUSTICI WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERVELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-585-3109
Mailing Address - Street 1:2307 NW SOUTH OUTER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-1712
Mailing Address - Country:US
Mailing Address - Phone:816-745-4532
Mailing Address - Fax:816-295-9909
Practice Address - Street 1:2307 NW SOUTH OUTER RD STE 101
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-1712
Practice Address - Country:US
Practice Address - Phone:816-745-4532
Practice Address - Fax:816-295-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty