Healthcare Provider Details

I. General information

NPI: 1538694583
Provider Name (Legal Business Name): OZARK UPPER CERVICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W. WASHINGTON STREET
SEYMOUR MO
65746
US

IV. Provider business mailing address

213 W. WASHINGTON STREET
SEYMOUR MO
65746
US

V. Phone/Fax

Practice location:
  • Phone: 417-935-2471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008008293
License Number StateMO

VIII. Authorized Official

Name: PAUL F HAMBRICK
Title or Position: OWNER
Credential: DC
Phone: 417-935-2471