Active NPI
Eda Danielle Deaton, LMT
- Massage Therapist
- Poplar Bluff, MO
National Provider Identifier
1689071276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2004020981
- Practice address
- 408 Vine St
Poplar Bluff, MO 63901-5838 - Phone
- (573) 686-1118
- Fax
- (573) 686-5109
- NPI assigned
- Nov 25, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 2004020981 | MO | Primary |
Addresses
Primary practice location
408 Vine St
Poplar Bluff, MO 63901-5838
Mailing address
408 Vine St
Poplar Bluff, MO 63901-5838
Phone (573) 686-1118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004020981 | MO | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chiropractic Life Center Poplar Bluff PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Poplar Bluff, MO
- NPI 1679887624
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416873600000",
"number": "1689071276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 VINE ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639015838",
"telephone_number": "573-686-1118",
"fax_number": "573-686-5109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 VINE ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639015838",
"telephone_number": "573-686-1118",
"fax_number": "573-686-5109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATON",
"first_name": "EDA",
"middle_name": "DANIELLE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-25",
"last_updated": "2014-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2004020981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.