Healthcare Provider Details

I. General information

NPI: 1851627566
Provider Name (Legal Business Name): PHARR CHIROPRACTIC AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

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: PATRICK KENNETH PHARR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 636-257-3895