Healthcare Provider Details

I. General information

NPI: 1225217144
Provider Name (Legal Business Name): VALLEY CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S MAIN ST
IRONTON MO
63650-1405
US

IV. Provider business mailing address

363 S MAIN ST
IRONTON MO
63650-1405
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-7517
  • Fax:
Mailing address:
  • Phone: 573-546-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5948
License Number StateMO

VIII. Authorized Official

Name: MRS. LAURIE L MCADAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 573-546-7517