Provider Demographics
NPI:1194998450
Name:ABSOLUTE WELLNESS CENTER, INC
Entity type:Organization
Organization Name:ABSOLUTE WELLNESS CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-346-3777
Mailing Address - Street 1:4203 E US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:LINN CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:65052-1745
Mailing Address - Country:US
Mailing Address - Phone:573-346-3777
Mailing Address - Fax:573-346-3891
Practice Address - Street 1:4203 E US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINN CREEK
Practice Address - State:MO
Practice Address - Zip Code:65052-1745
Practice Address - Country:US
Practice Address - Phone:573-346-3777
Practice Address - Fax:573-346-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005001318OtherLICENSE
MO1467450189OtherPERSONAL NPI
MO2005001318OtherLICENSE
MO000015705Medicare PIN