Provider Demographics
NPI:1548491269
Name:CHIROPRACTIC CONNECTION LLC
Entity type:Organization
Organization Name:CHIROPRACTIC CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-883-6102
Mailing Address - Street 1:535 ROZIER ST
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1557
Mailing Address - Country:US
Mailing Address - Phone:573-883-6102
Mailing Address - Fax:
Practice Address - Street 1:535 ROZIER ST
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1557
Practice Address - Country:US
Practice Address - Phone:573-883-6102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010149261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service