Provider Demographics
NPI:1043662570
Name:RESTORATION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RESTORATION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-476-1000
Mailing Address - Street 1:1413 GRINDSTONE PLAZA DR STE 109
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3794
Mailing Address - Country:US
Mailing Address - Phone:573-476-1000
Mailing Address - Fax:573-256-7378
Practice Address - Street 1:1413 GRINDSTONE PLAZA DR STE 109
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3794
Practice Address - Country:US
Practice Address - Phone:573-476-1000
Practice Address - Fax:573-256-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty