Provider Demographics
NPI:1780463398
Name:KEUTZER, JIMMY SCOTT (DC)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:SCOTT
Last Name:KEUTZER
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 1:3420 NW DUNCAN RD # 3
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6419
Mailing Address - Country:US
Mailing Address - Phone:417-262-3944
Mailing Address - Fax:
Practice Address - Street 1:3420 NW DUNCAN RD # 3
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6419
Practice Address - Country:US
Practice Address - Phone:417-262-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023035381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor