MEDICARE: PAUL R LUMPKIN JR DC CHIROPRACTOR INC

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	003358	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477578169	OTHER	MO	TYPE 1 NPI
2	33716	OTHER	MO	GHP
3	112106	OTHER	MO	HEALTHLINK
4	9732	OTHER	MO	BLUE CROSS BLUE SHIELD
5	4407500	OTHER	MO	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1770629743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL R LUMPKIN JR DC CHIROPRACTOR INC

Provider Business Mailing Address
First Line	:	409 W OSAGE ST
Second Line	:
City	:	PACIFIC
State	:	MO
Zip	:	63069-1332
Country	:	US
Telephone Number	:	636-271-2960
Fax Number	:	636-271-9165

Provider Business Practice Location Address
First Line	:	409 W OSAGE ST
Second Line	:
City	:	PACIFIC
State	:	MO
Zip	:	63069-1332
Country	:	US
Telephone Number	:	636-271-2960
Fax Number	:	636-271-9165

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL R LUMPKIN
Credential	:	DC
Telephone Number	:	636-271-2960

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/10/2012

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