Provider Demographics
NPI:1427343433
Name:OZARK WELLNESS PRACTICE, LLC
Entity type:Organization
Organization Name:OZARK WELLNESS PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-364-4647
Mailing Address - Street 1:1516 BRIDGESCHOOL RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8115
Mailing Address - Country:US
Mailing Address - Phone:573-364-4647
Mailing Address - Fax:573-364-4575
Practice Address - Street 1:1516 BRIDGESCHOOL RD STE A
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8115
Practice Address - Country:US
Practice Address - Phone:573-364-4647
Practice Address - Fax:573-364-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT103211017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty