Healthcare Provider Details

I. General information

NPI: 1629223425
Provider Name (Legal Business Name): COLE CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S. MAIN ST.
VANDALIA MO
63382-0149
US

IV. Provider business mailing address

PO BOX 149
VANDALIA MO
63382-0149
US

V. Phone/Fax

Practice location:
  • Phone: 573-594-2663
  • Fax: 573-594-2663
Mailing address:
  • Phone: 573-594-2663
  • Fax: 573-594-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006154
License Number StateMO

VIII. Authorized Official

Name: DR. MICHAEL R COLE
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 573-594-2663