Healthcare Provider Details

I. General information

NPI: 1588520506
Provider Name (Legal Business Name): BLAKELY JAN MORRISON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MAIN ST
GAINESVILLE MO
65655-8118
US

IV. Provider business mailing address

772 COUNTY ROAD 304
GAINESVILLE MO
65655-7506
US

V. Phone/Fax

Practice location:
  • Phone: 417-989-9480
  • Fax:
Mailing address:
  • Phone: 417-989-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2026000107
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: