Provider Demographics
NPI:1154927861
Name:ADVANCED CHIROPRACTIC AND REHAB OF EUREKA LLC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND REHAB OF EUREKA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-938-1010
Mailing Address - Street 1:223 SALT LICK RD # 280
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5974
Mailing Address - Country:US
Mailing Address - Phone:636-938-1010
Mailing Address - Fax:
Practice Address - Street 1:54 THE LEGENDS PKWY STE 158
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:636-938-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty