Healthcare Provider Details

I. General information

NPI: 1114864501
Provider Name (Legal Business Name): GRANT CHARLES BURNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 W 95TH ST
LENEXA KS
66215-5216
US

IV. Provider business mailing address

228 W 4TH ST APT 313
KANSAS CITY MO
64105-4510
US

V. Phone/Fax

Practice location:
  • Phone: 913-393-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2025053404
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: