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General NPI Number Information
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NPI Number | 1962659748
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Entity Type | Organization
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Legal Business Name | KADOLPH CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 1704 MAIN ST.
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City | BETHANY
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State | MO
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Zip | 64424-2064
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Country | US
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Telephone | 660-425-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 MAIN ST
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City | BETHANY
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State | MO
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Zip | 64424-2064
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Country | US
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Telephone | 660-425-3312
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELLY J. KADOLPH
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Credential |
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Telephone | 660-425-3312
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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 | 12301736
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License Number State | MO
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