Healthcare Provider Details

I. General information

NPI: 1891026852
Provider Name (Legal Business Name): K B SMITH, D.C., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 W 110TH ST BLDG 36
OVERLAND PARK KS
66210-1401
US

IV. Provider business mailing address

9209 W 110TH ST BLDG 36
OVERLAND PARK KS
66210-1401
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-8111
  • Fax: 913-912-5870
Mailing address:
  • Phone: 913-648-8111
  • Fax: 913-912-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberKS-01-04499
License Number StateKS

VIII. Authorized Official

Name: MS. GINA NINA NAMASTE
Title or Position: OFFICE MANAGER
Credential: C.A.
Phone: 913-648-8111