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General NPI Number Information
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NPI Number | 1366748378
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Entity Type | Organization
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Legal Business Name | REGIONAL PAIN AND REHAB CENTER, LLC
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 706 S KINGSHIGHWAY ST
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City | SIKESTON
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State | MO
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Zip | 63801-5918
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Country | US
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Telephone | 573-471-2453
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Fax | 573-643-9905
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Provider Business Mailing Address
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Address Line | 706 S KINGSHIGHWAY ST
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City | SIKESTON
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State | MO
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Zip | 63801-5918
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Country | US
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Telephone | 573-471-2453
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Fax | 573-643-9905
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JEFFREY CRAIG HARRISON
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Credential | D.C.
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Telephone | 573-471-2453
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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 | 005690
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License Number State | MO
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