Healthcare Provider Details

I. General information

NPI: 1952461170
Provider Name (Legal Business Name): SURFSIDE CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 HASTINGS ST.
MT. VERNON MO
65712-1020
US

IV. Provider business mailing address

731 HASTINGS ST.
MT. VERNON MO
65712-1020
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-7166
  • Fax: 417-466-7591
Mailing address:
  • Phone: 417-466-7166
  • Fax: 417-466-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006602
License Number StateMO

VIII. Authorized Official

Name: DR. DONNA L. MEYER
Title or Position: OWNER
Credential: D.C.
Phone: 417-466-7166