Healthcare Provider Details

I. General information

NPI: 1780265058
Provider Name (Legal Business Name): JUUL SPINE & SPORT CHIROPRACTIC, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
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 Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: KENNEDY J JUUL
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 573-796-3777