Provider Demographics
NPI:1023268109
Name:DOUGLASS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DOUGLASS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:417-451-1545
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty