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General NPI Number Information
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NPI Number | 1194926907
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Entity Type | Individual
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Provider Name | JONATHAN COOPER OWENS D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 104 MULLACH CT SUITE 1000
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City | WENTZVILLE
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State | MO
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Zip | 63385-4852
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Country | US
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Telephone | 636-327-0700
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Fax | 636-332-9103
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Provider Business Mailing Address
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Address Line | 1904 PROVIDENCE ESTATE DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-3717
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Country | US
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Telephone | 636-332-2569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2006028213
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License Number State | MO
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