MEDICARE: BLAKE OVERLY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2009013598	MO

General Provider Information

NPI Number	:	1134356637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE OVERLY DC

Provider Business Mailing Address
First Line	:	8002 N OAK TRFY
Second Line	:	SUITE 112
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1268
Country	:	US
Telephone Number	:	816-569-5079
Fax Number	:	816-569-5298

Provider Business Practice Location Address
First Line	:	8002 N OAK TRFY
Second Line	:	SUITE 112
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1268
Country	:	US
Telephone Number	:	816-569-5079
Fax Number	:	816-569-5298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	11/14/2011

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Directions to “ BLAKE OVERLY DC” Practice Location

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