Provider Demographics
NPI:1245354570
Name:TOWNE DRIVE MEDICAL CENTER,L.L.C
Entity type:Organization
Organization Name:TOWNE DRIVE MEDICAL CENTER,L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:573-474-8800
Mailing Address - Street 1:1621 TOWNE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3654
Mailing Address - Country:US
Mailing Address - Phone:573-474-8800
Mailing Address - Fax:573-474-8088
Practice Address - Street 1:1621 TOWNE DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3654
Practice Address - Country:US
Practice Address - Phone:573-474-8800
Practice Address - Fax:573-474-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID