NPIMap

Organization Active NPI

Family Wellness Chiropractic, LCC

  • Chiropractor
  • Ellisville, MO
National Provider Identifier
1104014521
Registry record updated Oct 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2005014052 Issued in MO
Legal business name
FAMILY WELLNESS CHIROPRACTIC, LCC
Practice address
355 Ozark Trail Dr Ste 9
Clayton-Clarkson Center
Ellisville, MO 63011-2164
Phone
(636) 527-5071
NPI assigned
Oct 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carrie Ann Jardine, DC
Title
Owner/Manager
Phone
(636) 527-5970

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2005014052 MO Primary
Clinic/Center 261Q00000X 2005014052 MO

Addresses

Primary practice location

355 Ozark Trail Dr Ste 9
Clayton-Clarkson Center
Ellisville, MO 63011-2164

Mailing address

355 Ozark Trail Dr Ste 9
Clayton-Clarkson Center
Ellisville, MO 63011-2164
Phone (636) 527-5071

Other identifiers 1

IdentifierTypeStateIssuer
1649471988OtherMONPI

National Provider Directory

National Provider Directory
Tax ID family
Family Wellness Chiropractic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

355 Ozark Trail Dr
Ste 9
Ellisville, MO 63011
Phone (636) 256-0707

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1104014521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 OZARK TRAIL DR STE 9",
            "address_2": "CLAYTON-CLARKSON CENTER",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112164",
            "telephone_number": "636-527-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 OZARK TRAIL DR STE 9",
            "address_2": "CLAYTON-CLARKSON CENTER",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112164",
            "telephone_number": "636-527-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CHIROPRACTIC, LCC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "JARDINE",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "636-527-5970",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2005014052",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MO",
            "license": "2005014052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649471988",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.