Provider Demographics
NPI:1427495977
Name:FOUNTAIN CITY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:FOUNTAIN CITY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-212-1713
Mailing Address - Street 1:8640 N GREEN HILLS RD STE 43
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1903
Mailing Address - Country:US
Mailing Address - Phone:847-212-1713
Mailing Address - Fax:
Practice Address - Street 1:8640 N GREEN HILLS RD STE 43
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1903
Practice Address - Country:US
Practice Address - Phone:847-212-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013011978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty