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General NPI Number Information
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NPI Number | 1922263524
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC OF MARYVILLE PC
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 1206 S MAIN ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2604
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Country | US
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Telephone | 660-582-5959
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Fax | 660-582-6373
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Provider Business Mailing Address
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Address Line | 1206 S MAIN ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2604
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Country | US
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Telephone | 660-582-5959
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Fax | 660-582-6373
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Authorized Official
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Title or Position | DR
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Name | RODNEY SMITH
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Credential | D.C.
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Telephone | 660-582-5959
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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 | 6457
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License Number State | MO
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