Provider Demographics
NPI:1588960868
Name:LAUNCH U JOPLIN INC
Entity type:Organization
Organization Name:LAUNCH U JOPLIN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-514-9455
Mailing Address - Street 1:4282 CART PATH
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8161
Mailing Address - Country:US
Mailing Address - Phone:812-514-9455
Mailing Address - Fax:
Practice Address - Street 1:1901 E 32ND ST
Practice Address - Street 2:STE 5
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3017
Practice Address - Country:US
Practice Address - Phone:417-623-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011000701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3421Medicare PIN