Doctor Name: | DR. MALLORY ANN PROVINCE |
NPI Number: | 1942611439 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DC |
License Number: | 2014013286 |
Business Practice Address: | 2318 E 32nd St Suite B Joplin, MO - 648044348 |
Business Phone Number: | 4177816300 |
Business Fax Number: | |
Mailing Address: | 2712 Corning Ave, PARSONS |
State: | KS |
Postal Code: | 673574008 |
Phone Number: | 6207782744 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2014 |
NPI Last Update Date: | 05/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 2014013286 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |