Healthcare Provider Details

I. General information

NPI: 1992725022
Provider Name (Legal Business Name): JON BARFKNECHT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROGERS ST
COLUMBIA MO
65216-0001
US

IV. Provider business mailing address

3806 GRANT LN
COLUMBIA MO
65203-6752
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-7407
  • Fax: 573-875-7415
Mailing address:
  • Phone: 573-489-5506
  • Fax: 573-875-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number107641
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: