Provider Demographics
NPI:1407934342
Name:VANCE, WILLIAM MCTEE (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MCTEE
Last Name:VANCE
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 1:415 S LAMINE AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4502
Mailing Address - Country:US
Mailing Address - Phone:660-827-4101
Mailing Address - Fax:
Practice Address - Street 1:415 S LAMINE AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-4502
Practice Address - Country:US
Practice Address - Phone:660-827-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO15615019OtherBCBS
MO15615019OtherBCBS
MOU05343Medicare UPIN