Provider Demographics
NPI:1902944705
Name:TWEEDIE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TWEEDIE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TELFER
Authorized Official - Last Name:TWEEDIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-777-4848
Mailing Address - Street 1:211 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1519
Mailing Address - Country:US
Mailing Address - Phone:417-777-4848
Mailing Address - Fax:417-777-3066
Practice Address - Street 1:211 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1519
Practice Address - Country:US
Practice Address - Phone:417-777-4848
Practice Address - Fax:417-777-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014855Medicare ID - Type Unspecified
319264855Medicare UPIN