Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2007023074 | MO |
N | 111NN1001X | Nutrition | 2007023074 | MO |
NPI | 1275716821 |
---|---|
Provider Name | Joseph Donald Worden III |
First Address | Pilot Knob, MO 63663-0306 |
Second Address | Pilot Knob, MO 63663-0306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 06/12/2007 |