Healthcare Provider Details

I. General information

NPI: 1639002728
Provider Name (Legal Business Name): MJN CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W SCHOOL ST
BONNE TERRE MO
63628-1509
US

IV. Provider business mailing address

21 W SCHOOL ST
BONNE TERRE MO
63628-1509
US

V. Phone/Fax

Practice location:
  • Phone: 573-358-7655
  • Fax:
Mailing address:
  • Phone: 573-358-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MASON PRATT
Title or Position: PROVIDER/OWNER
Credential: DC
Phone: 573-358-7655