Healthcare Provider Details

I. General information

NPI: 1386917797
Provider Name (Legal Business Name): 8 GATES NATURAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 ROE AVE SUITE 103
MISSION KS
66205-3008
US

IV. Provider business mailing address

PO BOX 45143
KANSAS CITY MO
64171-8143
US

V. Phone/Fax

Practice location:
  • Phone: 816-804-0185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2010000776
License Number StateMO

VIII. Authorized Official

Name: SARA R KORON
Title or Position: OWNER
Credential: L.AC.
Phone: 816-804-0185