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General NPI Number Information
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NPI Number | 1689957433
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Entity Type | Organization
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Legal Business Name | CROCKER CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 464 N JEFFERSON AVE
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City | LEBANON
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State | MO
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Zip | 65536-2742
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Country | US
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Telephone | 417-532-9166
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Fax | 417-532-9887
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Provider Business Mailing Address
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Address Line | 464 N JEFFERSON AVE
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City | LEBANON
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State | MO
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Zip | 65536-2742
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Country | US
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Telephone | 417-532-9166
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Fax | 417-532-9887
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK D CROCKER
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Credential | D.C.
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Telephone | 417-532-9166
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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 | MO004819
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License Number State | MO
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