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General NPI Number Information
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NPI Number | 1003016676
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Entity Type | Organization
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Legal Business Name | DESIRED HEALTH CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 530 N MIDDLE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1570
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Country | US
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Telephone | 573-756-6496
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Fax |
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Provider Business Mailing Address
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Address Line | 530 N MIDDLE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1570
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Country | US
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Telephone | 573-756-6496
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ADAM PAUL OVERCAST
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Credential | D.O.
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Telephone | 573-756-6496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2007020754
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License Number State | MO
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