Healthcare Provider Details

I. General information

NPI: 1003638149
Provider Name (Legal Business Name): SPIRIT CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WESTOVER RD
WHITEMAN AIR FORCE BASE MO
65305-1222
US

IV. Provider business mailing address

PO BOX 144
KNOB NOSTER MO
65336-0144
US

V. Phone/Fax

Practice location:
  • Phone: 906-399-1681
  • Fax:
Mailing address:
  • Phone: 906-399-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLIE GILLIS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 906-399-1681