MEDICARE: DR. MISTY MARIE OLBERDING D.C.

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	2007029649	MO

General Provider Information

NPI Number	:	1861674491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MISTY MARIE OLBERDING D.C.

Provider Business Mailing Address
First Line	:	604 S MAIN ST
Second Line	:
City	:	ROCK PORT
State	:	MO
Zip	:	64482-1448
Country	:	US
Telephone Number	:	660-744-2165
Fax Number	:	660-744-2062

Provider Business Practice Location Address
First Line	:	604 S MAIN ST
Second Line	:
City	:	ROCK PORT
State	:	MO
Zip	:	64482-1448
Country	:	US
Telephone Number	:	660-744-2165
Fax Number	:	660-744-2062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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