MEDICARE: DR. MICHELLE AFFOLTER

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	006705	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25302012	OTHER	MO	BLUE CROSS PROVIDER NUMBER

General Provider Information

NPI Number	:	1225296775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MICHELLE AFFOLTER

Provider Business Mailing Address
First Line	:	8101 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1202
Country	:	US
Telephone Number	:	816-436-5300
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. MICHELLE M AFFOLTER
Credential	:	D.C.
Telephone Number	:	816-436-5300

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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Directions to “DR. MICHELLE AFFOLTER ” Practice Location

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