Healthcare Provider Details

I. General information

NPI: 1760291272
Provider Name (Legal Business Name): EMMA MIZER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 FORUM BLVD STE 1
COLUMBIA MO
65203-5431
US

IV. Provider business mailing address

2614 FORUM BLVD STE 1
COLUMBIA MO
65203-5431
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2024050199
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: