Healthcare Provider Details

I. General information

NPI: 1952694317
Provider Name (Legal Business Name): VERNON PLACE PREVENTATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 ANTIOCH RD
MERRIAM KS
66202-3634
US

IV. Provider business mailing address

6301 ANTIOCH RD
MERRIAM KS
66202-3634
US

V. Phone/Fax

Practice location:
  • Phone: 913-839-7352
  • Fax:
Mailing address:
  • Phone: 913-839-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0105365
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0105365
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0105365
License Number StateKS

VIII. Authorized Official

Name: DR. COLE JACOB STEPHENS
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 913-839-7352