Healthcare Provider Details

I. General information

NPI: 1568160364
Provider Name (Legal Business Name): PECULIAR CHIROPRACTIC AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S STATE ROUTE C
PECULIAR MO
64078-9729
US

IV. Provider business mailing address

201 S STATE ROUTE C
PECULIAR MO
64078-9729
US

V. Phone/Fax

Practice location:
  • Phone: 816-779-1022
  • Fax:
Mailing address:
  • Phone: 816-779-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREK HAUG
Title or Position: OWNER
Credential: DC
Phone: 816-678-8178