Healthcare Provider Details

I. General information

NPI: 1881676781
Provider Name (Legal Business Name): EMMETT RAY REARY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W 3RD ST
SALEM MO
65560-1336
US

IV. Provider business mailing address

216 W 3RD ST
SALEM MO
65560-1336
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-2828
  • Fax: 573-729-0024
Mailing address:
  • Phone: 573-729-2828
  • Fax: 573-729-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: