Provider Demographics
NPI:1447035399
Name:POORTER, CODY KRAUTER
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:KRAUTER
Last Name:POORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 W 97TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4017
Mailing Address - Country:US
Mailing Address - Phone:727-256-4241
Mailing Address - Fax:
Practice Address - Street 1:10400 W 103RD ST STE 20
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2664
Practice Address - Country:US
Practice Address - Phone:913-385-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor