Healthcare Provider Details

I. General information

NPI: 1861674491
Provider Name (Legal Business Name): MISTY MARIE OLBERDING D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S MAIN ST
ROCK PORT MO
64482-1448
US

IV. Provider business mailing address

604 S MAIN ST
ROCK PORT MO
64482-1448
US

V. Phone/Fax

Practice location:
  • Phone: 660-744-2165
  • Fax: 660-744-2062
Mailing address:
  • Phone: 660-744-2165
  • Fax: 660-744-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2007029649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: