Healthcare Provider Details

I. General information

NPI: 1841873379
Provider Name (Legal Business Name): WILLIAM DAVID JUUL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 S OAK ST
CALIFORNIA MO
65018-1400
US

IV. Provider business mailing address

1116 S OAK ST
CALIFORNIA MO
65018-1400
US

V. Phone/Fax

Practice location:
  • Phone: 573-796-3777
  • Fax: 573-796-5043
Mailing address:
  • Phone: 573-796-3777
  • Fax: 573-796-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2021015448
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: