Provider Demographics
NPI:1407929847
Name:HUCK, JOSEPH BERNARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BERNARD
Last Name:HUCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1672
Mailing Address - Country:US
Mailing Address - Phone:573-438-5801
Mailing Address - Fax:573-438-7364
Practice Address - Street 1:502 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1672
Practice Address - Country:US
Practice Address - Phone:573-438-5801
Practice Address - Fax:573-438-7364
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43126Medicare UPIN