MEDICARE: CREATIVE WELLNESS CENTER

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	111NT0100X	Thermography Chiropractor	006799	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000B397	OTHER	MO	MEDICARE LEGACY

General Provider Information

NPI Number	:	1336220656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE WELLNESS CENTER

Provider Business Mailing Address
First Line	:	544 E 99TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4203
Country	:	US
Telephone Number	:	816-942-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 E 99TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4203
Country	:	US
Telephone Number	:	816-942-4700
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. MICHAEL E MARTIN
Credential	:	D.C.,N.D.
Telephone Number	:	816-942-4700

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	10/09/2007

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Directions to “CREATIVE WELLNESS CENTER ” Practice Location

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