Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 003881 | MO |
NPI | 1003023631 |
---|---|
Provider Name | Haydn Burk Powell JR. |
First Address | Salem, MO 65560 |
Second Address | Salem, MO 65560-2576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 19/08/2014 |