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General NPI Number Information
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NPI Number | 1497077101
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Entity Type | Organization
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Legal Business Name | MID-MISSOURI CLINIC OF CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 19 EAST WALNUT STREET SUITE F
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City | COLUMBIA
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State | MO
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Zip | 65203-4505
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Country | US
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Telephone | 573-256-6789
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Fax | 573-443-4821
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Provider Business Mailing Address
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Address Line | 19 EAST WALNUT STREET SUITE F
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City | COLUMBIA
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State | MO
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Zip | 65203-4505
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Country | US
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Telephone | 573-256-6789
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Fax | 573-443-4821
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS CAITLIN E HUNNICUTT
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Credential |
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Telephone | 573-256-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2008027069
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License Number State | MO
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