Provider Demographics
NPI:1245375690
Name:WEBB CHIROPRACTIC, P. C.
Entity type:Organization
Organization Name:WEBB CHIROPRACTIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-325-6334
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64840-0025
Mailing Address - Country:US
Mailing Address - Phone:417-325-6334
Mailing Address - Fax:417-325-5334
Practice Address - Street 1:101 S. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:MO
Practice Address - Zip Code:64840-0025
Practice Address - Country:US
Practice Address - Phone:417-325-6334
Practice Address - Fax:417-325-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001220Medicare ID - Type Unspecified
MOT43589Medicare UPIN