Healthcare Provider Details

I. General information

NPI: 1841645686
Provider Name (Legal Business Name): HEALTH SOURCE KC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 JUNIPER DR
ROELAND PARK KS
66205-2124
US

IV. Provider business mailing address

5424 JOHNSON DR
MISSION KS
66205-2911
US

V. Phone/Fax

Practice location:
  • Phone: 816-294-2281
  • Fax:
Mailing address:
  • Phone: 816-294-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN M. NADOLSKI
Title or Position: OWNER/CLINIC DIRECTOR
Credential: D.C
Phone: 816-294-2281