Healthcare Provider Details

I. General information

NPI: 1639342967
Provider Name (Legal Business Name): BRENDA CASEY CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 W 87TH ST
LENEXA KS
66219-1434
US

IV. Provider business mailing address

15545 W 87TH ST
LENEXA KS
66219-1434
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-4428
  • Fax: 913-894-4427
Mailing address:
  • Phone: 913-894-4428
  • Fax: 913-894-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04379
License Number StateKS

VIII. Authorized Official

Name: DR. BRENDA LEE CASEY
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 913-492-0122