Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006709 | MO |
NPI | 1003858440 |
---|---|
Provider Name | Dana Underkofler |
First Address | Chesterfield, MO 63017-5529 |
Second Address | Chesterfield, MO 63017-5529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 18/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U74611 | (02) | MO |