Healthcare Provider Details

I. General information

NPI: 1457417677
Provider Name (Legal Business Name): WILLIAM DALE HOFSTETTER JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N MAIN ST
BROOKFIELD MO
64628-1644
US

IV. Provider business mailing address

212 N MAIN ST
BROOKFIELD MO
64628-1644
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-4020
  • Fax: 660-258-4092
Mailing address:
  • Phone: 660-258-4020
  • Fax: 660-258-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCE006500
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: