Healthcare Provider Details

I. General information

NPI: 1295803419
Provider Name (Legal Business Name): KENNETH WAYNE NEIGHBORS C.O., B.O.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 OAKFIELD DR
COLUMBIA MO
65202-2280
US

IV. Provider business mailing address

2409 OAKFIELD DR
COLUMBIA MO
65202-2280
US

V. Phone/Fax

Practice location:
  • Phone: 573-268-6750
  • Fax:
Mailing address:
  • Phone: 573-268-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: