Healthcare Provider Details

I. General information

NPI: 1639317977
Provider Name (Legal Business Name): OZARK CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TORREY PINES DR
COLUMBIA MO
65203-4827
US

IV. Provider business mailing address

1301 TORREY PINES DR
COLUMBIA MO
65203-4827
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2761
  • Fax:
Mailing address:
  • Phone: 573-443-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number002607
License Number StateMO

VIII. Authorized Official

Name: DR. BEVERLY JEAN MILES
Title or Position: PRESIDENT
Credential: D.C.
Phone: 573-443-2761