Healthcare Provider Details

I. General information

NPI: 1073669917
Provider Name (Legal Business Name): EMILIO A JOHN D.C., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 W. 87TH ST. PARKWAY
LENEXA KS
66219
US

IV. Provider business mailing address

15545 W. 87TH ST. PARKWAY
LENEXA KS
66219
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-0770
  • Fax: 913-894-4427
Mailing address:
  • Phone: 913-894-0770
  • Fax: 913-894-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-3994
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: