Healthcare Provider Details

I. General information

NPI: 1033078969
Provider Name (Legal Business Name): NATHAN DAVID CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E REPUBLIC RD STE A104
SPRINGFIELD MO
65804-4645
US

IV. Provider business mailing address

2144 E REPUBLIC RD STE A104
SPRINGFIELD MO
65804-4645
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-8075
  • Fax: 417-887-8535
Mailing address:
  • Phone: 417-887-8075
  • Fax: 417-887-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2025053721
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2025053721
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: