Provider Demographics
NPI:1982757811
Name:SHORTER, CHRIS M (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:M
Last Name:SHORTER
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 1:1347 S GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0301
Mailing Address - Country:US
Mailing Address - Phone:417-877-7800
Mailing Address - Fax:417-887-8990
Practice Address - Street 1:1347 S GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0301
Practice Address - Country:US
Practice Address - Phone:417-877-7800
Practice Address - Fax:417-887-8990
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004026604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO257361092Medicare ID - Type UnspecifiedMEDICARE NUMBER
MOV03184Medicare UPIN