Healthcare Provider Details

I. General information

NPI: 1457541658
Provider Name (Legal Business Name): TALLEY CHIROPRACTIC OFFICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S WOOD ST
NEOSHO MO
64850-1857
US

IV. Provider business mailing address

317 S WOOD ST
NEOSHO MO
64850-1857
US

V. Phone/Fax

Practice location:
  • Phone: 417-451-1545
  • Fax: 417-451-1548
Mailing address:
  • Phone: 417-451-1545
  • Fax: 417-451-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number002172
License Number StateMO

VIII. Authorized Official

Name: DR. LARRY LERICHARD TALLEY
Title or Position: PRESIDENT/DOCTOR
Credential: D.C.
Phone: 417-451-1545