Healthcare Provider Details

I. General information

NPI: 1700127172
Provider Name (Legal Business Name): AARON JAMES CUNNINGHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 CARTER LN SUITE 103
COLUMBIA MO
65201-5898
US

IV. Provider business mailing address

312 W WIGHTMAN ST
MOBERLY MO
65270-3428
US

V. Phone/Fax

Practice location:
  • Phone: 573-239-6112
  • Fax:
Mailing address:
  • Phone: 573-239-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2013006290
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: