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General NPI Number Information
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NPI Number | 1811177967
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Entity Type | Organization
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Legal Business Name | SIRAGUSO CHIROPRACTIC INC.
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 113 BLUE JAY DR SUITE 106
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City | LIBERTY
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State | MO
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Zip | 64068-1997
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Country | US
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Telephone | 816-415-2900
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Fax | 816-415-2903
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Provider Business Mailing Address
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Address Line | 113 BLUE JAY DR SUITE 106
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City | LIBERTY
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State | MO
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Zip | 64068-1997
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Country | US
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Telephone | 816-415-2900
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Fax | 816-415-2903
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. VINCENT CARL SIRAGUSO
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Credential | D.C.
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Telephone | 816-415-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 006282
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License Number State | MO
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