Healthcare Provider Details

I. General information

NPI: 1093088320
Provider Name (Legal Business Name): FIT MUSCLE & JOINT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22120 MIDLAND DR STE 1
SHAWNEE KS
66226-3554
US

IV. Provider business mailing address

22120 MIDLAND DR STE 1
SHAWNEE KS
66226-3554
US

V. Phone/Fax

Practice location:
  • Phone: 913-745-4064
  • Fax: 913-745-4352
Mailing address:
  • Phone: 913-745-4064
  • Fax: 913-745-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW MILLER LANE
Title or Position: DOCTOR/CO-OWNER
Credential: DC
Phone: 913-745-4064