Healthcare Provider Details

I. General information

NPI: 1306909114
Provider Name (Legal Business Name): MISSION CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6556 JOHNSON DR
MISSION KS
66202-2615
US

IV. Provider business mailing address

6556 JOHNSON DR
MISSION KS
66202-2615
US

V. Phone/Fax

Practice location:
  • Phone: 913-432-4780
  • Fax: 913-262-2690
Mailing address:
  • Phone: 913-432-4780
  • Fax: 913-262-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRAD S WILLITS
Title or Position: SOLE MEMBER
Credential: D. C.
Phone: 913-432-4780