Provider Demographics
NPI:1689061368
Name:BELLEVILLE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BELLEVILLE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOLTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-346-4749
Mailing Address - Street 1:302 W 4TH ST
Mailing Address - Street 2:P. O. BOX 173
Mailing Address - City:PORTIS
Mailing Address - State:KS
Mailing Address - Zip Code:67474-9260
Mailing Address - Country:US
Mailing Address - Phone:785-346-4749
Mailing Address - Fax:
Practice Address - Street 1:1325 18TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2280
Practice Address - Country:US
Practice Address - Phone:785-346-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty