Healthcare Provider Details

I. General information

NPI: 1154664266
Provider Name (Legal Business Name): AARON CUNNINGHAM DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 CARTER LN STE 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 Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2013006290
License Number StateMO

VIII. Authorized Official

Name: DR. AARON CUNNINGHAM
Title or Position: OWNER
Credential:
Phone: 573-239-6112