Provider Demographics
NPI:1952526923
Name:NEVADA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:NEVADA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEISENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-667-3699
Mailing Address - Street 1:200 S ALMA ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3945
Mailing Address - Country:US
Mailing Address - Phone:417-667-3699
Mailing Address - Fax:417-667-3699
Practice Address - Street 1:200 S ALMA ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3945
Practice Address - Country:US
Practice Address - Phone:417-667-3699
Practice Address - Fax:417-667-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODRC 006411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23118015OtherBLUE CROSSBLUESHIELD
MO0009785Medicare ID - Type Unspecified
MOU57404Medicare UPIN