Healthcare Provider Details

I. General information

NPI: 1659526713
Provider Name (Legal Business Name): HAWK RIDGE CHIROPRACTIC AND ACUPUNCTURE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 LAMP AND LANTERN VLG
TOWN AND COUNTRY MO
63017-8209
US

IV. Provider business mailing address

39 A PRETORIA DRIVE
ELLISVILLE MO
63021
US

V. Phone/Fax

Practice location:
  • Phone: 636-227-4949
  • Fax:
Mailing address:
  • Phone: 636-346-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA KAY RODENBAUGH
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 636-346-7861