Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006088 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 006088 | MO |
NPI | 1033191689 |
---|---|
Provider Name | Dr. Charles Meyer Vifquain |
First Address | Lees Summit, MO 64063-2333 |
Second Address | Lees Summit, MO 64063-2333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 24/03/2010 |