Provider Demographics
NPI:1427234657
Name:I-70 CHIROPRACTOR, P.C.
Entity type:Organization
Organization Name:I-70 CHIROPRACTOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TINDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-463-1400
Mailing Address - Street 1:311 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-9668
Mailing Address - Country:US
Mailing Address - Phone:660-463-1400
Mailing Address - Fax:
Practice Address - Street 1:311 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-9668
Practice Address - Country:US
Practice Address - Phone:660-463-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000B834Medicare UPIN