Individual
MR. JACK PERCY DILLENDER II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
709 MANOR DR, COLUMBIA, MO 65203-1737
(573) 814-1418
Mailing address
709 MANOR DR, 2101CORONA ROAD #201, COLUMBIA, MO 65203-1737
(573) 814-1418
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2002028196
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002028196
MASSAGE THERAPY
MO
Enumeration date
05/07/2009
Last updated
05/07/2009
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