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General NPI Number Information
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NPI Number | 1043662570
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Entity Type | Organization
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Legal Business Name | RESTORATION CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 1413 GRINDSTONE PLAZA DR STE 109
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City | COLUMBIA
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State | MO
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Zip | 65201-3794
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Country | US
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Telephone | 573-476-1000
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Fax | 573-256-7378
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Provider Business Mailing Address
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Address Line | 1413 GRINDSTONE PLAZA DR STE 109
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City | COLUMBIA
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State | MO
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Zip | 65201-3794
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Country | US
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Telephone | 573-476-1000
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Fax | 573-256-7378
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. TAYLOR JOHN SIROIS
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Credential | DC
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Telephone | 573-476-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2016017211
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License Number State | MO
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