Provider Demographics
NPI:1194869396
Name:TREADWELL, DAVID BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:TREADWELL
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 1:801 E MAIN ST
Mailing Address - Street 2:P.O. BOX 344
Mailing Address - City:PRINCETON
Mailing Address - State:MO
Mailing Address - Zip Code:64673-1239
Mailing Address - Country:US
Mailing Address - Phone:660-748-4015
Mailing Address - Fax:660-748-4115
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:801 E MAIN P.O. 344
Practice Address - City:PRINCETON
Practice Address - State:MO
Practice Address - Zip Code:64673-1239
Practice Address - Country:US
Practice Address - Phone:660-748-4015
Practice Address - Fax:660-748-4115
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor