Healthcare Provider Details

I. General information

NPI: 1780906685
Provider Name (Legal Business Name): JFC CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 E OHIO ST
CLINTON MO
64735-2401
US

IV. Provider business mailing address

1743 E OHIO ST
CLINTON MO
64735-2401
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-0700
  • Fax: 660-890-0705
Mailing address:
  • Phone: 660-890-0700
  • Fax: 660-890-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2009032238
License Number StateMO

VIII. Authorized Official

Name: JERALD F COOLEY
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 660-890-0700