Desoto Chiropractic, P.C.
Organization Active NPI Chiropractor · De Soto, MO
NPI 1053596478 · NPPES record last updated Jan 3, 2008
Key facts
- NPI
- 1053596478
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2004035442 (MO)
- Legal business name
- DESOTO CHIROPRACTIC, P.C.
- Practice address
- 112 N Main St
De Soto, MO 63020-1709 - Phone
- (636) 586-4226
- Fax
- (636) 586-3791
- NPI assigned
- Jan 3, 2008
- Organization subpart
- No
Authorized official
- Name
- Jeffrey Daniel Carpenter, D.C.
- Title
- Owner
- Phone
- (636) 586-4226
Practitioners 2
-
Jeffrey D Carpenter, D.C.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2033709 | Desoto Chiropractic | Certificate of waiver | Dec 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050915000604 | MO | Part B Supplier - Clinic/Group Practice | 3870526221 |
Receives reassigned benefits from 1 practitioner Practice locations: De Soto, MO |
National Provider Directory
Locations
112 N Main St
De Soto, MO 63020
Phone (636) 586-4226
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2004035442 | MO | Yes |
Addresses
Primary practice location
112 N Main St
De Soto, MO 63020-1709
Mailing address
112 N Main St
De Soto, MO 63020-1709
Phone (636) 586-4226
Other providers in De Soto, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.