Healthcare Provider Details

I. General information

NPI: 1982878286
Provider Name (Legal Business Name): KIRCHNER CHIROPRACTIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 W COMMERCIAL ST
KAHOKA MO
63445-1453
US

IV. Provider business mailing address

PO BOX 13
KAHOKA MO
63445-0013
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-3677
  • Fax:
Mailing address:
  • Phone: 660-727-3677
  • Fax: 660-727-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number002829
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number2006021033
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number2007031161
License Number StateMO

VIII. Authorized Official

Name: DR. KELLEY RENAE KIRCHNER
Title or Position: OWNER
Credential: D. C.
Phone: 660-727-3677