MEDICARE: DR. NALISA LOUISE POULIOT D.C.

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	006425	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24021014	OTHER	MO	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1952322604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NALISA LOUISE POULIOT D.C.

Provider Business Mailing Address
First Line	:	4321 NE VIVION RD
Second Line	:	SUITE 102
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2838
Country	:	US
Telephone Number	:	816-453-3331
Fax Number	:	816-453-3331

Provider Business Practice Location Address
First Line	:	4321 NE VIVION RD
Second Line	:	SUITE 102
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2838
Country	:	US
Telephone Number	:	816-453-3331
Fax Number	:	816-453-3331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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