Provider Demographics
NPI:1235321001
Name:KANSAS CITY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:KANSAS CITY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-753-4600
Mailing Address - Street 1:4700 BELLEVIEW AVE
Mailing Address - Street 2:SUITE L12
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1378
Mailing Address - Country:US
Mailing Address - Phone:816-753-4600
Mailing Address - Fax:816-753-4620
Practice Address - Street 1:4700 BELLEVIEW AVE
Practice Address - Street 2:SUITE L12
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1378
Practice Address - Country:US
Practice Address - Phone:816-753-4600
Practice Address - Fax:816-753-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030424111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP81C720Medicare PIN