Healthcare Provider Details

I. General information

NPI: 1023564614
Provider Name (Legal Business Name): CHRIS HAPPEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 1ST ST
WARRENTON MO
63383-2606
US

IV. Provider business mailing address

707 FIRST ST
WARRENTON MO
63383
US

V. Phone/Fax

Practice location:
  • Phone: 636-352-6274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: