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General NPI Number Information
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NPI Number | 1144763756
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Entity Type | Organization
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Legal Business Name | HEARTLAND CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 3874 E JACKSON BLVD
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City | JACKSON
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State | MO
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Zip | 63755-3710
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Country | US
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Telephone | 573-243-8983
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Fax | 573-243-7209
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Provider Business Mailing Address
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Address Line | 3874 E JACKSON BLVD
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City | JACKSON
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State | MO
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Zip | 63755-3710
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Country | US
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Telephone | 573-243-8983
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Fax | 573-243-7209
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANDI WOOD
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Credential | DC
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Telephone | 573-243-7246
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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 | 2016026188
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License Number State | MO
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