417 Performance Chiro LLC
Chiropractor in Springfield, MO. Organization (NPI-2).
NPI number1770326480
StatusActive
Last updated in NPPESJun 18, 2024
Details
- NPI
- 1770326480
- Entity type
- Organization (NPI-2)
- Legal business name
- 417 Performance Chiro LLC
- Organization subpart
- No
- Enumeration date
- Jun 18, 2024
- Certification date
- Jun 18, 2024
- Last updated
- Jun 18, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | – | – | Yes |
Practice location
4728 S Campbell Ave Ste 132Springfield, MO 65810-1715
Phone 417-597-3777
Mailing address
4728 S Campbell Ave Ste 132Springfield, MO 65810-1715
Phone 417-597-3777
Authorized official
Anthony C Bolin
Director/Doctor
4174252759
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