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General NPI Number Information
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NPI Number | 1992953327
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Entity Type | Organization
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Legal Business Name | ANDREWS CHIROPRACTIC & ACUPUNCTURE CENTER OF SEMO,LLC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 3874 E JACKSON BLVD
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City | JACKSON
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State | MO
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Zip | 63755-3710
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Country | US
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Telephone | 573-243-8983
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Fax | 573-243-7209
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Provider Business Mailing Address
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Address Line | 3874 E JACKSON BLVD
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City | JACKSON
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State | MO
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Zip | 63755-3710
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Country | US
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Telephone | 573-243-8983
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Fax | 573-243-7209
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | KHONDA S ANDREWS
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Credential | DC
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Telephone | 573-243-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 004660
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License Number State | MO
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