Provider Demographics
NPI:1194916643
Name:NEPTUNE CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:NEPTUNE CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MURRAY
Authorized Official - Last Name:NEPTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF CHIROPRACT
Authorized Official - Phone:417-863-1434
Mailing Address - Street 1:1525 A WEST SUNSHINE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2311
Mailing Address - Country:US
Mailing Address - Phone:417-863-1434
Mailing Address - Fax:417-863-1468
Practice Address - Street 1:1525 A WEST SUNSHINE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2311
Practice Address - Country:US
Practice Address - Phone:417-863-1434
Practice Address - Fax:417-863-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MO005608111N00000X
MO006686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
990001803Medicare PIN