Organization
SJ BLACK INVESTMENTS LLC
Active
Other names
Active Chiropractic & Spinal Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SETH BLACK D.C. (OWNER)
(573) 268-8226
Entity
Organization
Contact information
Practice address
501A SOUTH FRANKLIN STREET, CUBA, MO 65453
(573) 268-8226
Mailing address
501A SOUTH FRANKLIN STREET, CUBA, MO 65453
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2008001513
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149800001
MEDICARE PTAN
MO
01
—
1508044991
PROVIDER INDIVIDUAL NPI NUMBER
MO
Enumeration date
07/06/2011
Last updated
07/06/2011
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