Provider Demographics
NPI:1003638149
Name:SPIRIT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SPIRIT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-399-1681
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-0144
Mailing Address - Country:US
Mailing Address - Phone:906-399-1681
Mailing Address - Fax:
Practice Address - Street 1:340 WESTOVER RD
Practice Address - Street 2:
Practice Address - City:WHITEMAN AIR FORCE BASE
Practice Address - State:MO
Practice Address - Zip Code:65305-1222
Practice Address - Country:US
Practice Address - Phone:906-399-1681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty