Provider Demographics
NPI:1780906685
Name:JFC CHIROPRACTIC
Entity type:Organization
Organization Name:JFC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-890-0700
Mailing Address - Street 1:1743 E OHIO ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2401
Mailing Address - Country:US
Mailing Address - Phone:660-890-0700
Mailing Address - Fax:660-890-0705
Practice Address - Street 1:1743 E OHIO ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2401
Practice Address - Country:US
Practice Address - Phone:660-890-0700
Practice Address - Fax:660-890-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty