MEDICARE: DYNAMIC CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1205309242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2525 NW SOUTH OUTER RD STE C
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-1726
Country	:	US
Telephone Number	:	816-800-8305
Fax Number	:	816-307-7279

Provider Business Practice Location Address
First Line	:	2525 NW SOUTH OUTER RD STE C
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-1726
Country	:	US
Telephone Number	:	816-800-8305
Fax Number	:	816-307-7279

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. DILLON JAMES MARTINEK
Credential	:	DC
Telephone Number	:	816-457-7135

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	05/08/2024

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