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General NPI Number Information
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NPI Number | 1417194739
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Entity Type | Organization
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Legal Business Name | MALDEN CHIROPRACTIC HEALTH CENTER, P.C.
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 2103 N DOUGLASS ST
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City | MALDEN
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State | MO
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Zip | 63863-1141
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Country | US
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Telephone | 573-276-3892
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Fax | 573-276-6600
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Provider Business Mailing Address
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Address Line | 2103 N DOUGLASS ST
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City | MALDEN
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State | MO
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Zip | 63863-1141
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Country | US
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Telephone | 573-276-3892
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Fax | 573-276-6600
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MR. LAWRENCE J STOVALL
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Credential | D.C.
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Telephone | 573-276-3892
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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 | 004373
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License Number State | MO
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