Healthcare Provider Details

I. General information

NPI: 1780321711
Provider Name (Legal Business Name): SUMMIT HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10423 OLD HWY 54 SUITE B
NEW BLOOMFIELD MO
65063-6506
US

IV. Provider business mailing address

75 S LARAND DR
HOLTS SUMMIT MO
65043-1132
US

V. Phone/Fax

Practice location:
  • Phone: 573-896-8008
  • Fax:
Mailing address:
  • Phone: 157-329-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY E CHITWOOD
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 573-896-8008