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General NPI Number Information
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NPI Number | 1386826089
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Entity Type | Organization
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Legal Business Name | SELLERS FAMILY CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 405 WAL MART DRIVE
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City | SULLIVAN
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State | MO
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Zip | 63080
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Country | US
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Telephone | 573-468-8884
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Fax | 573-468-8886
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Provider Business Mailing Address
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Address Line | 405 WAL MART DRIVE
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City | SULLIVAN
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State | MO
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Zip | 63080
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Country | US
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Telephone | 573-468-8884
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Fax | 573-468-8886
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Authorized Official
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Title or Position | OWNER PROPRIETOR
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Name | CLYDE W SELLERS
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Credential | DC
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Telephone | 573-468-8884
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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 | 006772
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License Number State | MO
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