MEDICARE: GLADSTONE CHIROPRACTIC INC

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	:	1912649971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADSTONE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	7626 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1751
Country	:	US
Telephone Number	:	360-452-7636
Fax Number	:	360-457-4221

Provider Business Practice Location Address
First Line	:	7626 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1751
Country	:	US
Telephone Number	:	360-452-7636
Fax Number	:	360-457-4221

Authorized Official
Title or Position	:	OWER
Name	:	DUSTIN JAROD CLARK
Credential	:	DC
Telephone Number	:	360-452-7636

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	05/24/2022

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Directions to “GLADSTONE CHIROPRACTIC INC ” Practice Location

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