Provider Demographics
NPI:1316174535
Name:UTTERBACK CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:UTTERBACK CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:HEDGES
Authorized Official - Last Name:UTTERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-965-8084
Mailing Address - Street 1:140 W ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4023
Mailing Address - Country:US
Mailing Address - Phone:314-965-8084
Mailing Address - Fax:314-965-8612
Practice Address - Street 1:140 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4023
Practice Address - Country:US
Practice Address - Phone:314-965-8084
Practice Address - Fax:314-965-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000279261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center