Provider Demographics
NPI:1124247291
Name:STILL, BRUCE HARRY (DC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:HARRY
Last Name:STILL
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 1:903 N COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1231
Mailing Address - Country:US
Mailing Address - Phone:816-380-3555
Mailing Address - Fax:
Practice Address - Street 1:903 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1231
Practice Address - Country:US
Practice Address - Phone:816-380-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22776015OtherBLUE CROSS BLUE SHIELD
0009170Medicare ID - Type Unspecified
U39584Medicare UPIN