Provider Demographics
NPI:1982675732
Name:WRIGHT, DOUGLAS CORDELL (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CORDELL
Last Name:WRIGHT
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 1:10655 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-5094
Mailing Address - Country:US
Mailing Address - Phone:636-789-2287
Mailing Address - Fax:636-789-3371
Practice Address - Street 1:10655 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5094
Practice Address - Country:US
Practice Address - Phone:636-789-2287
Practice Address - Fax:636-789-3371
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO288972OtherHEALTHLINK
431850003OtherHUMANA
MO4405200OtherMEDICARE COMPLETE
MO431850003OtherFIRST HEALTH
MO4405200OtherUNITED HEALTHCARE
MO5462510OtherAETNA
MO7708OtherBLUE CROSS/BLUE SHIELD
MO1030830OtherCIGNA
MO24852V34261OtherGHP
MOU60609OtherMERCY
MO5462510OtherAETNA
MO431850003OtherFIRST HEALTH
MO4405200OtherMEDICARE COMPLETE