Healthcare Provider Details

I. General information

NPI: 1134045495
Provider Name (Legal Business Name): TYRUS D FORT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 E KANSAS CITY RD
OLATHE KS
66061-7050
US

IV. Provider business mailing address

10501 W 113TH ST APT 5462
OVERLAND PARK KS
66210-2583
US

V. Phone/Fax

Practice location:
  • Phone: 913-791-0144
  • Fax: 816-368-9584
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-06483
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: