Provider Demographics
NPI:1861679383
Name:DOUGLASS, JIMMIE L III (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:L
Last Name:DOUGLASS
Suffix:III
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 1:317 S WOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1857
Mailing Address - Country:US
Mailing Address - Phone:417-451-1545
Mailing Address - Fax:417-451-1548
Practice Address - Street 1:317 S WOOD ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1857
Practice Address - Country:US
Practice Address - Phone:417-451-1545
Practice Address - Fax:417-451-1548
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000770111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic