MEDICARE: ADVANCED HEALTH 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	2006012466	MO

General Provider Information

NPI Number	:	1922011055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALTH CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	244 E US HIGHWAY 69
Second Line	:	#202
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3115
Country	:	US
Telephone Number	:	816-453-1198
Fax Number	:	816-479-2933

Provider Business Practice Location Address
First Line	:	244 E US HIGHWAY 69
Second Line	:	#202
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3115
Country	:	US
Telephone Number	:	816-453-1198
Fax Number	:	816-479-2933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHERYL L GOLLADAY
Credential	:	DC
Telephone Number	:	816-453-1198

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/19/2011

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