MEDICARE: JOPLIN CHIROPRACTIC CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	004984	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	167051	OTHER	MO	HEALTHLINK
2	189392	OTHER	MO	CARPENTERS/GHP
3	8778	OTHER	MO	BLUE CROSS/ANTHEM

General Provider Information

NPI Number	:	1700031978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOPLIN CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	307 N FREDERICK ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5627
Country	:	US
Telephone Number	:	573-335-9229
Fax Number	:	573-339-0994

Provider Business Practice Location Address
First Line	:	307 N FREDERICK ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5627
Country	:	US
Telephone Number	:	573-335-9229
Fax Number	:	573-339-0994

Authorized Official
Title or Position	:	BILLING
Name	:	STACEY L GALLAHER
Credential	:
Telephone Number	:	573-335-1779

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	03/03/2009

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Directions to “JOPLIN CHIROPRACTIC CLINIC ” Practice Location

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