Basic Information
| Provider Information | |||||||||
| NPI: | 1093904856 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINNER CHIROPRACTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4245 OLD HIGHWAY 100 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630905714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145701952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 E 6TH ST | ||||||||
| Address2: | STE. B | ||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630903111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362399997 | ||||||||
| FaxNumber: | 6362399931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | MINNER | ||||||||
| AuthorizedOfficialFirstName: | MEGAN | ||||||||
| AuthorizedOfficialMiddleName: | KATHLEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3145701952 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2007027755 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.