Healthcare Provider Details

I. General information

NPI: 1407182116
Provider Name (Legal Business Name): PATRICK KENNETH PHARR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 W OSAGE ST
PACIFIC MO
63069-3430
US

IV. Provider business mailing address

2726 W OSAGE ST
PACIFIC MO
63069-3430
US

V. Phone/Fax

Practice location:
  • Phone: 636-257-3895
  • Fax: 636-257-3872
Mailing address:
  • Phone: 636-257-3895
  • Fax: 636-257-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2009026118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: