Provider Demographics
NPI:1770629743
Name:PAUL R LUMPKIN JR DC CHIROPRACTOR INC
Entity Type:Organization
Organization Name:PAUL R LUMPKIN JR DC CHIROPRACTOR INC
Other - Org Name:PAUL R LUMPKIN DC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-271-2960
Mailing Address - Street 1:409 W OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1332
Mailing Address - Country:US
Mailing Address - Phone:636-271-2960
Mailing Address - Fax:636-271-9165
Practice Address - Street 1:409 W OSAGE ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1332
Practice Address - Country:US
Practice Address - Phone:636-271-2960
Practice Address - Fax:636-271-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477578169OtherTYPE 1 NPI
MO33716OtherGHP
MO112106OtherHEALTHLINK
MO9732OtherBLUE CROSS BLUE SHIELD
MO4407500OtherUNITED HEALTH CARE
MO112106OtherHEALTHLINK
MO4407500OtherUNITED HEALTH CARE
MO9732OtherBLUE CROSS BLUE SHIELD
MO1477578169OtherTYPE 1 NPI