Provider Demographics
NPI:1821217654
Name:JOPLIN DISC AND PAIN SOLUTIONS
Entity Type:Organization
Organization Name:JOPLIN DISC AND PAIN SOLUTIONS
Other - Org Name:RENUVA BACK AND PAIN CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-781-3472
Mailing Address - Street 1:2302 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4301
Mailing Address - Country:US
Mailing Address - Phone:417-781-3472
Mailing Address - Fax:417-781-1774
Practice Address - Street 1:2302 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4301
Practice Address - Country:US
Practice Address - Phone:417-781-3472
Practice Address - Fax:417-781-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-4728111N00000X
MO2010010250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1700998721OtherINDIVIDUAL NPI
KS$$$$$$$$$OtherSOCIAL SECURITY NUMBER
6147920002Medicare NSC
KS513864224OtherSOCIAL SECURITY NUMBER