Provider Demographics
NPI:1962966234
Name:KOELLING FAMILY CHIROPRACTIC JEFFCITY
Entity type:Organization
Organization Name:KOELLING FAMILY CHIROPRACTIC JEFFCITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOELLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-606-6970
Mailing Address - Street 1:3702 W TRUMAN BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-4970
Mailing Address - Country:US
Mailing Address - Phone:573-606-6970
Mailing Address - Fax:573-298-6392
Practice Address - Street 1:3702 W TRUMAN BLVD STE 218
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4970
Practice Address - Country:US
Practice Address - Phone:573-310-9391
Practice Address - Fax:573-310-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty