Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 004435 | MO |
N | 111NI0013X | Independent Medical Examiner | 004435 | MO |
NPI | 1407890148 |
---|---|
Provider Name | William Van Nessing |
First Address | Florissant, MO 63031-4919 |
Second Address | Saint Charles, MO 63301-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 26/08/2021 |