Provider Demographics
NPI:1386850048
Name:COLE FAMILY CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:COLE FAMILY CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-646-1377
Mailing Address - Street 1:803 ADAM DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3901
Mailing Address - Country:US
Mailing Address - Phone:660-646-1377
Mailing Address - Fax:660-646-3314
Practice Address - Street 1:803 ADAM DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3901
Practice Address - Country:US
Practice Address - Phone:660-646-1377
Practice Address - Fax:660-646-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT300000Medicare ID - Type Unspecified