Provider Demographics
NPI:1891972014
Name:GRASHER, JODY L (DC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:GRASHER
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 1:1304 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-9326
Mailing Address - Country:US
Mailing Address - Phone:816-456-5644
Mailing Address - Fax:
Practice Address - Street 1:712 S BROADWAY
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-8102
Practice Address - Country:US
Practice Address - Phone:816-690-8383
Practice Address - Fax:816-690-9781
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor