Organization
D. J. FAHNESTOCK, D. C., P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL JEWELL FAHNESTOCK D. C. (PRESIDENT)
(660) 886-6903
Entity
Organization
Contact information
Practice address
269 S JEFFERSON AVE, MARSHALL, MO 65340-2134
(660) 886-6903
(660) 886-6904
Mailing address
269 S JEFFERSON AVE, MARSHALL, MO 65340-2134
(660) 886-6903
(660) 886-6904
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
003184
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03801016
BLUE CROSS BLUE SHIELD OF KC
MO
01
—
115444
HEALTHLINK
—
01
—
T73635
UPIN
MO
Enumeration date
04/28/2008
Last updated
05/30/2008
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