Provider Demographics
NPI:1235868449
Name:MID-MO CHIROPRACTIC
Entity Type:Organization
Organization Name:MID-MO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-651-5255
Mailing Address - Street 1:3685 COUNTY ROAD 2130
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65259-2792
Mailing Address - Country:US
Mailing Address - Phone:660-651-5255
Mailing Address - Fax:
Practice Address - Street 1:1600 N MORLEY ST STE D
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3666
Practice Address - Country:US
Practice Address - Phone:660-651-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty