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General NPI Number Information
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NPI Number | 1275905424
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Entity Type | Organization
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Legal Business Name | KIRKSVILLE FOOT & SHOE
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 202 N FRANKLIN ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2917
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Country | US
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Telephone | 660-730-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 202 N FRANKLIN ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2917
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Country | US
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Telephone | 660-730-5030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TED DEININGER
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Credential | BOCOP
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Telephone | 660-988-4271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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