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General NPI Number Information
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NPI Number | 1235881467
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Entity Type | Organization
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Legal Business Name | COMPOSITE REHAB & CHIROPRACTIC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 10 HI LINE DR
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City | UNION
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State | MO
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Zip | 63084-3104
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Country | US
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Telephone | 636-221-7471
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Fax |
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Provider Business Mailing Address
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Address Line | 121 E 6TH ST
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City | WASHINGTON
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State | MO
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Zip | 63090-2703
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Country | US
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Telephone | 636-221-7471
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JOSEPH MICHAEL GARRISON
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Credential | DC
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Telephone | 636-221-7471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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