Healthcare Provider Details

I. General information

NPI: 1356405062
Provider Name (Legal Business Name): COE ANN HARDWICK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W PIERCE
KIRKSVILLE MO
63501
US

IV. Provider business mailing address

PO BOX 245 109 W PIERCE ST
KIRKSVILLE MO
63501
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-2311
  • Fax: 660-665-6611
Mailing address:
  • Phone: 660-665-2311
  • Fax: 660-665-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5890
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5890
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: