PRO ACTIVE CHIROPRACTIC CENTER PC — NPI 1750560751 (Licensed & Credentialed Chiropractic Providers

CMS-1500 Box 24J / 33a • NPI

1750560751

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

111N00000X (CMS 35)

Licensed & Credentialed Chiropractic Providers — Chiropractor

Box 32 Service Location & ZIP+4

219 S MAIN ST, PALMYRA, MO, 63461-1649

✓ 9-Digit EDI 837 ZIP+4 (63461-1649)

Practice Phone & Referral Fax

(573) 769-2400

Fax: (573) 769-0600

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1750560751 (PRO ACTIVE CHIROPRACTIC CENTER PC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1750560751` (NPI-2 Organization / Facility)
Provider / Legal Name	PRO ACTIVE CHIROPRACTIC CENTER PC
Plain-English Specialty	Licensed & Credentialed Chiropractic Providers — Chiropractor NUCC Code: `111N00000X` (Chiropractor)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	219 S MAIN ST, PALMYRA, MO, 63461-1649
Practice Telephone / Fax	Tel: (573) 769-2400 \| Fax: (573) 769-0600
Administrative Mailing Address	219 S MAIN ST, PALMYRA, MO, 63461-1649
Enumeration & Last Sync	Enumerated: 2007-10-26 \| CMS Record Updated: 2025-02-26
Authorized Official	JOHN STIFFEY (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

219 S MAIN ST, PALMYRA, MO, 63461-1649

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Plain-English Taxonomy & CMS Crosswalk (111N00000X)

What Does Taxonomy Code 111N00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 111N00000X translates to:
"Licensed & Credentialed Chiropractic Providers — Chiropractor"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 35 (Chiropractic)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Chiropractor for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PRO ACTIVE CHIROPRACTIC CENTER PC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`111N00000X` — Chiropractor Plain English: Licensed & Credentialed Chiropractic Providers — Chiropractor	State: MO \| License: `2002004526` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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PRO ACTIVE CHIROPRACTIC CENTER PC (NPI #1750560751)