Healthcare Provider Details

I. General information

NPI: 1518949031
Provider Name (Legal Business Name): JOHN THOMAS HALLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SW 12TH ST
OAK GROVE MO
64075-0957
US

IV. Provider business mailing address

105 SW 12TH ST
OAK GROVE MO
64075-0957
US

V. Phone/Fax

Practice location:
  • Phone: 816-625-4580
  • Fax: 816-625-4580
Mailing address:
  • Phone: 816-625-4580
  • Fax: 816-625-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006682
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: