Pro Active Chiropractic Center PC
Organization Active NPI Chiropractor · Palmyra, MO
NPI 1750560751 · NPPES record last updated Feb 26, 2025
Key facts
- NPI
- 1750560751
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2002004526 (MO)
- Legal business name
- PRO ACTIVE CHIROPRACTIC CENTER PC
- Practice address
- 219 S Main St
Palmyra, MO 63461-1649 - Phone
- (573) 769-2400
- Fax
- (573) 769-0600
- NPI assigned
- Oct 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. John Scott Stiffey, D.C.
- Title
- President
- Phone
- (573) 769-2400
Practitioners 2
-
John Scott Stiffey, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060302000532 | MO | Part B Supplier - Clinic/Group Practice | 5294741054 |
Receives reassigned benefits from 1 practitioner Practice locations: Palmyra, MO |
National Provider Directory
Locations
219 S Main St
Palmyra, MO 63461
Phone (573) 769-2400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2002004526 | MO | Yes |
Addresses
Primary practice location
219 S Main St
Palmyra, MO 63461-1649
Mailing address
219 S Main St
Palmyra, MO 63461-1649
Phone (573) 769-2400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000014883 | Other | MO | MEDICARE GROUP |
Other providers in Palmyra, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.