Provider Demographics
NPI:1346795234
Name:CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-825-6555
Mailing Address - Street 1:1747 SMIZER STATION RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2784
Mailing Address - Country:US
Mailing Address - Phone:636-825-6555
Mailing Address - Fax:
Practice Address - Street 1:1747 SMIZER STATION RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2784
Practice Address - Country:US
Practice Address - Phone:636-825-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty