Provider Demographics
NPI:1023324753
Name:DUNLAP CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:DUNLAP CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:417-624-1276
Mailing Address - Street 1:102 N RANGE LINE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1602
Mailing Address - Country:US
Mailing Address - Phone:417-624-1276
Mailing Address - Fax:417-624-7513
Practice Address - Street 1:102 N RANGE LINE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1602
Practice Address - Country:US
Practice Address - Phone:417-624-1276
Practice Address - Fax:417-624-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO752700609Medicaid
MO752700609Medicaid
MO31163Medicare PIN