=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588960868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUNCH U JOPLIN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2011
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 E 32ND ST STE 5
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64804-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-623-8187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4282 CART PATH
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-8161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-514-9455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BART ANDERSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 812-514-9455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2011000701
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------