Healthcare Provider Details

I. General information

NPI: 1790979474
Provider Name (Legal Business Name): ODESSA CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S 2ND ST
ODESSA MO
64076-1248
US

IV. Provider business mailing address

216 S 2ND ST
ODESSA MO
64076
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-5355
  • Fax: 816-633-5356
Mailing address:
  • Phone: 816-633-5355
  • Fax: 816-633-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY ALAN KESEMANN
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 816-633-5355